ESIS Senior Claims Representative, WC

Chubb•Buffalo, NY

1d•$71,000 - $104,000

About The Position

Under direct supervision initially, performs customer service and claims functions while training to become a claims representative. Gains exposure to all facets of a professional claims representative role through classroom and hands-on learning. As training progresses, will be assigned a caseload.

Requirements

Minimum of 2 years of experience handling workers’ compensation claims
Bachelor’s degree or equivalent experience
An applicable resident or designated home state adjuster’s license is required for ESIS Field Claims Adjusters
Candidates who do not meet the licensing requirement will not meet ESIS employment requirements for handling claims

Nice To Haves

Experience with ESIS or a similar third-party administrator is preferred
Strong knowledge of workers’ compensation laws, medical terminology, and claims handling best practices
Proficiency in claims management systems and Microsoft Office Suite
Excellent written and verbal communication skills, including the ability to communicate effectively with external investigative sources and insureds by phone
Strong teamwork skills, with the ability to give and receive constructive feedback and identify growth opportunities
Strong analytical and problem-solving abilities
Ability to manage multiple priorities and meet deadlines in a fast-paced environment
Strong customer service focus and a proactive approach to supporting customer needs
Sound judgment and decision-making skills, with the ability to support and defend decisions
Commitment to high standards of performance and professionalism
Flexibility to adapt approach and behavior to different situations
Ability to represent Chubb and ESIS positively
ESIS supports independent self-study time and allows up to 4 months to pass the adjuster licensing exam

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.