ESIS Claims Representative, WC

Chubb•Portland, OR

About The Position

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. Under the direction of the Claims Team Leader, the Senior Workers’ Compensation Claim Representative investigates and resolves claims promptly, fairly, and in accordance with established best practices.

Requirements

2–4 years of experience handling workers’ compensation claims.
Strong communication and interpersonal skills, with the ability to interact professionally and effectively with claimants, customers, insureds, brokers, attorneys, and other stakeholders.
Ability to work independently, manage priorities, and take initiative.
Knowledge of company products, services, coverages, policy limits, and claims best practices.
Strong negotiation skills.
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 handling workers’ compensation claims in California is preferred.

Responsibilities

Under limited supervision, receives assignments and reviews claim and policy information to support the investigation and determine the extent of the policy’s obligation to the insured, depending on the line of business.
Contacts, interviews, and obtains statements from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather necessary claim information.
Evaluates facts obtained through investigation to determine the extent of liability, if any, and the company’s obligation to the insured under the policy contract.
Prepares reports related to investigations, settlements, claim denials, and evaluations of involved parties.
Sets reserves within authority limits and recommends reserve changes to the Team Leader.
Reviews claim progress and status with the Team Leader and discusses issues and recommended corrective actions.
Submits unusual or potentially adverse exposures to the Team Leader for review.
Assists the Team Leader in developing methods and process improvements for claims handling.
Settles claims promptly and fairly.
Obtains releases, proofs of loss, or compensation agreements and issues company drafts for claim payments.
Informs claimants, insureds/customers, or attorneys of claim denials when applicable.