ESIS Senior Claims Representative, WC

Chubb•Phoenix, AZ

About The Position

Under the direction of the Claims Team Leader, the ESIS Senior Claim Representative investigates and resolves claims promptly, fairly, and in accordance with established best practices. This role handles more complex claims and requires strong technical skills. ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS’ innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients’ unique risk management needs. With more than 70 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industry’s broadest selections of risk management solutions covering both pre- and post-loss services.

Requirements

3–5 years of experience handling workers’ compensation claims
Knowledge of California and/or Nevada workers’ compensation requirements
Ability to follow legal, regulatory, and company-specific requirements.
Ability to meet quality review standards by following established claims handling procedures.
Ability to follow ESIS best practices and adhere to client and carrier guidelines to support accurate documentation, claims handling, and service delivery.
Strong analytical and problem-solving skills
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 claims 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.

Nice To Haves

Experience with ESIS or a similar third-party administrator is preferred.
Active adjuster license or the ability to obtain licensure within a specified timeframe.

Responsibilities

Investigate, evaluate, and manage workers’ compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
Serve as a 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 responsive 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 support effective claim outcomes.