ESIS Senior Claims Representative, WC

Chubb•Paradise, NV

3d•$78,100 - $105,000

About The Position

ESIS, a Chubb company, is seeking a Senior Claims Representative to investigate, evaluate, manage, and settle workers’ compensation claims promptly, equitably, and in accordance with applicable laws, regulations, company policies, and established best practices. The role handles complex and intricate claims and reports to the Claims Team Leader. The representative serves as a primary contact for injured workers, employers, medical providers, and other stakeholders; conducts investigations; makes claim acceptance, denial, and settlement decisions; maintains detailed claim files; manages claim costs and reserves; and works with legal, medical, and risk management teams. The position also involves providing client service, meeting quality standards, following ESIS best practices and client and carrier requirements, and complying with applicable jurisdictional reporting requirements. The pay range is $78,100 to $105,000, with the specific offer dependent on skills and other factors. The role may also be eligible for a discretionary annual incentive program. Chubb offers a comprehensive benefits package; details are available on its careers website. The pay range may be adjusted for geographic differentials.

Requirements

A minimum of 3–5 years of experience handling workers’ compensation claims.
Knowledge of Nevada and/or California workers’ compensation.
An active adjuster license or ability to obtain licensure within the specified timeframe. ESIS allows up to four months to pass the adjuster licensing exam.
For ESIS Field Claims Adjusters, an applicable resident or designated home state adjuster’s license is required.
Strong analytical and problem-solving abilities.
Excellent verbal and written communication skills.
Proficiency with 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.
Ability to comply with legal, regulatory, company-specific, client, and carrier requirements.

Nice To Haves

Prior experience with ESIS or similar third-party administrators.

Responsibilities

Investigate, evaluate, and manage workers’ compensation claims from inception through resolution, including complex claims.
Communicate professionally with injured workers, employers, medical providers, and other stakeholders throughout the claims process.
Conduct investigations by gathering statements, reviewing medical records, and analyzing accident reports to determine compensability and liability.
Make timely and accurate decisions regarding claim acceptance, denial, and settlement based on case facts and applicable laws.
Maintain detailed, organized claim files documenting activities, communications, and decisions in the claims management system.
Monitor and manage medical expenses, indemnity payments, and legal fees, and establish and maintain appropriate reserves.
Ensure compliance with applicable state workers’ compensation laws, regulations, reporting requirements, and company policies.
Address client inquiries, resolve issues, and provide timely claim-status updates.
Collaborate with internal legal, medical, and risk management professionals to achieve optimal claim outcomes.
Follow ESIS best practices and client and carrier guidelines, and meet established quality review standards.