ESIS Claims Representative, WC

JOB DESCRIPTION

KEY OBJECTIVE:

Responsibilities include investigating claims to determine extent of injury, reserving and effective case management.

Utilize medical cost containment measures to control loss dollar pay-out.

Review status of claims and develop strategies to effectively manage to conclusion.

Consistent delivery of superior customer service.

MAJOR DUTIES & RESPONSIBILITIES:


* Handle multiple demands & priorities, from a variety of sources, simultaneously


* Maintain ESIS Standards & Best Practices


* Adjust claims with the ability to follow company policies and procedures


* Have the ability to effectively and independently manage and maintain a workers compensation pending.


* Handle and resolve conflict effectively


* Meet goals & objectives established by ESIS and the Claims Vice President


* Escalate issues appropriately and follow through


* Be a problem solver with excellent problem resolution skills


* Meet and maintain customer service requirements and have the ability to follow ESIS processes.


* Make sound judgment decisions and have the ability to differentiate information.


* Communicate effectively both written & orally


* Respond to customers appropriately, timely & accurately


* Ability to remain calm and professional during peak periods of activity.


* Handle multiple computer applications and vendor systems to manage caseloads


* Identify and determine short term and long term financial exposures and establish accurate financial reserves to meet Client, ESIS and Carrier expectations


* Effectively and accurately manage large sums of client or carrier funds


* Comply with all statutory reporting and licensing requirements for multiple jurisdictions


* Determine, calculate and issue accurate benefit payments to injured workers, medical providers and vendors in a timely fashion


* Clearly and concisely document the ESIS claim system with activities, investigations and plans in a timely fashion

QUALIFICATIONS



* Qualified candidates must possess experience 5 or more years in managing workers compensation claims investigation/ adjusting, including knowledge of applicable state/local legislation.


* Experience in a third party administrator (TPA) environment is a plus.


* Knowledge of Workers' Compensation laws and procedures are required.


* Candidates must have the ability to work independently, while assimilating various technical subjects, as evidenced by successful completion of a college degree or equivalent practical work experience.


* AIC/CPCU is preferred


* Candidates must also have solid computer software skills (M/S Word, Excel).

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 comp...