ESIS Senior Claims Representative, WC

Chubb•Phoenix, AZ

About The Position

ESIS, a leader in risk management and insurance services, is seeking a Senior California Claim Representative to investigate and resolve workers' compensation claims promptly, equitably, and in accordance with established best practices. This role involves managing complex cases, acting as a primary point of contact for stakeholders, conducting thorough investigations, making timely decisions, maintaining detailed documentation, managing claim costs, ensuring compliance with state-specific laws, and providing exceptional customer service. The Senior Claim Representative will collaborate with internal teams to achieve optimal claim outcomes.

Requirements

Minimum of 3–5 years handling workers' compensation claims.
Knowledge of California Workers’ Compensation regulations.
An active adjuster license, or the ability to obtain licensure within a specified timeframe.
Ensures compliance with all legal, regulatory, and company-specific requirements.
Achieves strong quality review scores by consistently adhering to established high-standard procedures.
Follows ESIS Best Practices and adheres to client and carrier guidelines 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 preferred.

Responsibilities

Investigate, evaluate, and manage workers' compensation claims from initiation to resolution, ensuring compliance with relevant laws, regulations, and company policies.
Act as the primary point of contact for injured individuals, 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, while ensuring appropriate reserves are established and maintained.
Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.
Provide exceptional service 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.