ESIS Claims Representative, WC

Chubb•Portland, OR

5d•Onsite

About The Position

Are you looking to grow your career in workers’ compensation and claims support? Join ESIS, a leader in risk management and insurance services, where you can help support effective claims handling and contribute to positive outcomes for employees and clients. The ESIS Claim Representative, reporting to the Claims Team Leader, is responsible for investigating and resolving claims promptly, equitably, and in accordance with established best practices.

Requirements

Minimum of 2–3 years of experience managing workers' compensation claims
Experience with ESIS or a similar third-party administrator is preferred.
Knowledge of California workers’ compensation regulations
An active adjuster license, or the ability to obtain licensure within a specified timeframe.
Strong analytical and problem-solving skills.
Excellent verbal and written communication abilities.
Proficiency with claims management systems and Microsoft Office Suite.
Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Familiarity with workers’ compensation laws, medical terminology, and claim handling best practices.
An applicable resident or designated home state adjuster’s license is required for ESIS Field Claims Adjusters.
Adjusters that do not fulfill the license requirements will not meet ESIS’s employment requirements for handling claims.
ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.

Nice To Haves

experience with ESIS or a similar third-party administrator is preferred.

Responsibilities

Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
Act as the primary point of contact for injured workers, employers, medical providers, and other stakeholders, delivering clear and professional communication throughout the claims process.
Conduct thorough investigations, 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 case facts and applicable laws.
Maintain detailed and organized claim files, documenting all activities, communications, and decisions within the claims management system.
Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, 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.