ESIS Senior Claims Representative, WC

About the position

The ESIS Senior Workers’ Compensation Claim Representative, under the direction of the Claims Team Leader, is responsible for investigating and resolving claims promptly, fairly, 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.

Responsibilities

• Receives assignments and reviews claim and policy information to provide background for investigations, and may determine the extent of the policy’s obligation to the insured, depending on the line of business.
• Contacts, interviews, and obtains statements from insured parties, claimants, witnesses, medical professionals, legal representatives, law enforcement, and other relevant individuals to gather necessary claim information.
• Evaluates facts obtained during investigations to determine the extent of liability and the company’s obligation under the policy contract.
• Prepares reports detailing investigations, settlements, claim denials, and evaluations of involved parties.
• Sets reserves within authority limits and recommends reserve changes to the Team Leader.
• Reviews the progress and status of claims with the Team Leader, discussing challenges and recommending remedial actions.
• Prepares and submits unusual or potentially undesirable exposures to the Team Leader for review.
• Assists the Team Leader in developing methods and improvements for handling claims.
• Resolves claims promptly and fairly.
• Obtains releases, proofs of loss, or compensation agreements, and issues company drafts for claim payments.
• Communicates claim denials to claimants, insured parties, customers, or legal representatives as appropriate.

Requirements

• Minimum of four years of experience managing workers’ compensation claims.
• Demonstrated ability to communicate clearly and professionally, with strong interpersonal skills for effective interactions with claimants, customers, insured parties, brokers, attorneys, and other stakeholders.
• Proven ability to work independently and demonstrate self-motivation.
• Solid understanding of company products, services, coverages, policy limits, and claims best practices.
• Strong negotiation skills.
• 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

• Experience handling workers’ compensation claims in Oregon or Hawaii is preferred.

Benefits

• Comprehensive benefits package