JOB DESCRIPTION

Are you ready to make a meaningful impact in the field of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your expertise can help create safer workplaces and support employees during critical times. At ESIS, we are committed to delivering exceptional service and innovative solutions, and we seek dedicated professionals to join our dynamic team. If you are looking to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation opportunities and discover how you can contribute to a brighter future for all employees.

We are seeking a skilled Senior Claims Representative to strengthen our team. Reporting to the Claims Team Leader, this role is essential in investigating and managing claims promptly and equitably, in accordance with established best practices.

This is a hybrid position, requiring three days per week in-office.

Position Overview: The ESIS Senior California Claim Representative, under the direction of the Claims Team Leader, investigates and resolves claims efficiently, equitably, and in line with best practice guidelines.

Key Responsibilities:

• Claims Management: Investigate, evaluate, and manage workers' compensation claims from initiation to resolution, ensuring compliance with all relevant laws, regulations, and company policies. As a Senior Claim Representative, you will handle more complex cases that require advanced expertise.
• Communication: Act as the primary contact for injured workers, employers, medical providers, and other stakeholders, ensuring clear and professional communication throughout the claims process.
• Investigation: Conduct comprehensive investigations, 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 case facts and applicable laws.
• Documentation: Maintain organized and detailed 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, ensuring appropriate reserves are established and maintained.
• Compliance: Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.
• Customer Service: Deliver exceptional service to clients by addressing inquiries, resolving issues, and providing 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 3-5 years of experience managing workers' compensation claims; prior experience with ESIS or similar third-party administrators is preferred.
• Jurisdiction & Licensing: Knowledge of California Workers' Compensation regulations and an active adjuster license, or the ability to obtain licensure within a specified timeframe.
• Compliance: Maintains compliance with all legal, regulatory, and company-specific requirements.
• Quality Review Performance: Consistently achieves strong quality review scores by following established high-standard procedures.
• ESIS/Client/Carrier Requirements: Adheres to ESIS Best Practices and complies with client and carrier guidelines to ensure accuracy in documentation, claims handling, and service delivery.
• Skills:
  • Strong analytical and problem-solving skills.
  • Excellent verbal and written communication abilities.
  • Proficiency with claims management systems and Microsoft Office Suite.
  • Ability to manage multiple priorities and meet deadlines in a fast-paced environment.

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.

The pay range for the role is $78, 100 to $109, 400. 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.

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.

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 distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.

At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.