ESIS Senior Claims Representative, WC

Chubb•Phoenix, AZ

13d

About The Position

ESIS, a leader in risk management and insurance services, is seeking a Senior Claim Representative to support effective claims handling and contribute to positive outcomes for employees and clients. The Senior Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably, and within established best practices guidelines. This role is responsible for more complex and intricate claims, requiring an advanced skillset.

Requirements

Minimum of 3-5 years of experience handling workers' compensation claims.
Knowledge of California and/or Nevada Workers Compensation.
Active adjuster license or ability to obtain licensure within a specified timeframe.
Ensures compliance with all legal, regulatory and company-specific requirements.
Achieves strong quality review scores by adhering to established high standard procedures.
Follows ESIS Best Practices; adheres to client and carrier guidelines and requirements to ensure accuracy in documentation, claims handling and service delivery.
Strong analytical and problem-solving abilities.
Excellent verbal and written communication skills.
Proficiency in 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

Prior experience with ESIS or similar third-party administrators is a plus.

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.