ESIS Claims Representative, WC

Chubb • Los Angeles, CA

2d • $62,700 - $81,300

About The Position

Under direct supervision initially, performs customer service and/or claims functions while training to become a claims representative. Gains exposure to all facets of a professional claims representative position through classroom and hands on learning. Will be assigned a caseload as training progresses.

Requirements

• Customer service and/or claims functions experience
• Ability to investigate, evaluate, and manage claims
• Strong communication skills
• Ability to conduct thorough investigations
• Decision-making skills regarding claim acceptance, denial, or settlement
• Ability to maintain detailed and organized claim files
• Ability to monitor and manage claim costs
• Knowledge of state-specific workers' compensation laws and regulations
• Ability to provide exceptional customer service
• Collaboration skills

Responsibilities

• Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
• Serve as the primary point of contact for injured workers, employers, medical providers, and other stakeholders, providing clear and professional communication throughout the claims process.
• Conduct thorough investigations of claims, including gathering statements, reviewing medical records, and analyzing accident reports to determine compensability and liability.
• Make timely and accurate decisions regarding claim acceptance, denial, or settlement based on the facts of the case and applicable laws.
• Maintain detailed and organized claim files, documenting all activities, communications, and decisions in the claims management system.
• Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while ensuring appropriate reserves are established and maintained.
• Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.
• Provide exceptional service to clients by addressing inquiries, resolving issues, and delivering timely updates on claim status.
• Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed