ESIS Senior Claims Representative, WC

Are you looking to grow your career in workers’ compensation and claims support? Join ESIS, a leader in risk management and insurance services, where you can help support effective claims handling and contribute to positive outcomes for employees and clients.

ESIS is seeking a Senior Claim Representative to support the management of workers’ compensation claims. In this role, you will investigate, evaluate, and resolve claims in a timely and equitable manner in accordance with established guidelines, applicable laws, and company policies.

Responsibilities may include:

• Claims Management: Manage workers’ compensation claims from intake through resolution, including more complex files that require advanced judgment and technical expertise.
• Communication: Serve as a 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 claim investigations by gathering statements, reviewing medical records, and analyzing accident reports to assess compensability and liability.
• Decision-Making: Make timely and well-supported decisions regarding claim acceptance, denial, or settlement based on the facts of the case and applicable laws.
• Documentation: Maintain accurate and organized claim files, documenting all activities, communications, and decisions in the claims management system.
• Cost Control: Monitor claim costs, including medical expenses, indemnity payments, and legal fees, and ensure appropriate reserves are established and maintained.
• Compliance: Ensure adherence to state-specific workers’ compensation laws, regulations, and reporting requirements.
• Customer Service: Provide responsive service to clients by addressing inquiries, resolving issues, and delivering timely claim updates.
• Collaboration: Work closely with internal teams, including legal, medical, and risk management professionals, to support effective claim resolution.

• Experience: 3–5 years of experience handling workers’ compensation claims. Experience with ESIS or a similar third-party administrator is preferred.
• Jurisdiction and Licensing: Knowledge of California and/or Nevada workers’ compensation requirements, along with an active adjuster license or the ability to obtain licensure within the required timeframe.
• Compliance: Ability to follow legal, regulatory, and company-specific requirements.
• Quality Review Performance: Ability to meet quality review expectations by following established procedures and standards.
• ESIS, Client, and Carrier Requirements: Ability to follow ESIS best practices and client/carrier guidelines to support accurate documentation, claims handling, and service delivery.
• Skills:
  • Strong analytical and problem-solving skills
  • 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
• Knowledge: Familiarity with workers’ compensation laws, medical terminology, and claim handling best practices. This role involves handling more complex claims and requires strong technical and professional judgment.

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.

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.

The pay range for the role is $71,000 to $104,000. The specific offer will depend on an applicant’s skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program.  Chubb offers a comprehensive benefits package, more details on which can be found on our careers website.  The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.