ESIS Senior Claims Representative, DBA

JOB DESCRIPTION

Duties may include but are not limited to:


* Claims Management: Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.

As a Senior Claim Representative, candidate will be responsible for more complex and intricate, requiring an advanced skillset.


* Communication: 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.


* Investigation: Conduct thorough investigations of claims, including gathering statements, reviewing medical records, and analyzing accident reports to determine compensability and liability.


* Decision-Making: Make timely and accurate decisions regarding claim acceptance, denial, or settlement based on the facts of the case and applicable laws.


* Documentation: Maintain detailed and organized claim files, documenting all activities, communications, and decisions in the claims management system.


* Cost Control: Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while ensuring appropriate reserves are established and maintained.


* Compliance: Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.


* Customer Service: Provide exceptional service to clients by addressing inquiries, resolving issues, and delivering timely updates on claim status.


* Collaboration: Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.

QUALIFICATIONS



* Experience: Minimum of 5+ years of experience handling workers' compensation claims; prior experience with ESIS or similar third-party administrators is a plus.


* Knowledge & Licensing: Knowledge of Defense Based Act/Longshore claims and active adjuster license or ability to obtain licensure within a specified timeframe.


* Skills:
+ 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.


* Knowledge: Familiarity with workers' compensation laws, medical terminology, and claim handling best practices.

As a Senior Claim Representative, candidate will be responsible for more complex and intricate, requiring an advanced skillset.

ABOUT US

Chubb is a world leader in insurance.

With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients.

The company is distinguished by its extensive product and service offerings, broad...