ESIS Senior Claims Representative, WC

Chubb • Phoenix, AZ

3d

About The Position

The ESIS Senior California Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines. As a Senior Claim Representative, candidate will be responsible for more complex and intricate, requiring an advanced skillset.

Requirements

• Minimum of 3-5 years of experience handling workers' compensation claims
• Knowledge of California 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

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed