ESIS Claims Representative, WC

ESIS Claims Representative, WC, Dallas, Texas

Key Objective: Investigate workers’ compensation claims to determine the extent of injury, establish accurate reserves, and manage cases effectively through resolution. Use medical cost containment strategies to help control loss costs while delivering consistent, high-quality customer service.

Major Duties & Responsibilities:

Manage multiple priorities and demands from various sources simultaneously

Maintain ESIS standards and best practices

Adjust claims in accordance with company policies and procedures

Independently manage a workers’ compensation pending caseload

Resolve conflict effectively and professionally

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

Escalate issues appropriately and follow through to resolution

Apply strong problem-solving and issue-resolution skills

Meet customer service expectations and follow ESIS processes

Exercise sound judgment and distinguish relevant information

Communicate clearly and effectively, both verbally and in writing

Respond to customers promptly, accurately, and professionally

Remain calm and professional during periods of high activity

Use multiple computer applications and vendor systems to manage caseloads

Identify short- and long-term financial exposures and establish accurate reserves in line with client, ESIS, and carrier expectations

Manage large sums of client or carrier funds accurately and effectively

Comply with statutory reporting and licensing requirements across multiple jurisdictions

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

Document claim activity, investigations, and action plans clearly, concisely, and promptly in the ESIS claim system

Candidates must have 5 or more years of experience managing workers’ compensation claims investigations and adjusting, including knowledge of applicable state and local legislation.

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

Knowledge of workers’ compensation laws and procedures is required.

Candidates must be able to work independently and assimilate technical subject matter, as demonstrated by a college degree or equivalent practical work experience.

AIC or CPCU designation is preferred.

Candidates must have strong computer skills, including Microsoft Word and Excel.

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.