ESIS Senior Claims Representative, WC

Chubb•Phoenix, AZ

1d•Hybrid

About The Position

ESIS is seeking a skilled Senior Claims Representative to enhance our team. This role plays a vital part in investigating and managing claims promptly and equitably, in line with established best practices. This is a hybrid position, with three days per week in-office. The ESIS Senior Nevada Claim Representative, under the direction of the Claims Team Leader, investigates and resolves claims promptly, equitably, and in accordance with established best practices. 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

Minimum of 3–5 years handling workers' compensation claims
Prior experience with ESIS or similar third-party administrators is preferred.
Knowledge of Nevada Workers Compensation
An active adjuster license, or the ability to obtain licensure within a specified timeframe.
Demonstrated ability to ensure compliance with all legal, regulatory, and company-specific requirements.
Consistently achieves high quality review scores by following established procedures and standards.
Adheres to ESIS Best Practices and client/carrier guidelines to ensure accuracy in documentation, claims handling, and service delivery.
Advanced analytical and problem-solving skills
Excellent verbal and written communication abilities
Proficiency in claims management systems and Microsoft Office Suite
Strong organizational skills with the 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.
Senior Claim Representatives are expected to handle more complex and intricate claims, requiring advanced expertise.
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 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.