ESIS Senior Claims Representative, WC

Chubb
US - Hawaii - Honolulu
December 25, 2024

The ESIS Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.

Duties may include but are not limited to:

Receive assignments.
Reviews claim and policy information to provide background for investigation and may determine the extent of the policy's obligation to the insured depending on the line of business.
Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc.
to secure necessary claim information.
Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company's obligation to the insured under the policy contract.
Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
Sets reserves within authority limits and recommends reserve changes to Team Leader.
Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
Prepares and submits to Team Leader unusual or possible undesirable exposures.
Assists Team Leader in developing methods and improvements for handling claims.
Settles claims promptly and equitably.
Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
Informs claimants, insureds/customers or attorney of denial of claim when applicable.
May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements.
Continues efforts to settle claims before trial.
Refers claims to subrogation as appropriate.
May participate in claim file reviews and audits with customer/insured and broker.
Administers benefits timely and appropriately.
Maintains control of claim's resolution process to minimize current exposure and future risks
Establishes and maintains strong customer relations

Depending on line of business, other duties may include:

Maintaining system logs
Investigating compensability and benefit entitlement
Reviewing and approving medical bill payments
Managing vocational rehabilitation

Qualifications

3-5 years' experience handling claims in a relevant line of business.
Basic knowledge of claims handling and familiarity with claims terminologies
Effective negotiation skills
Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc.
in a positive manner concerning losses.
Ability to self-motivate and work independently
Knowledge of company products, services, coverage's and policy limits, along with awareness of the company's claims best practices
Knowledge of applicable state and local laws
California Certification required
Self-insured certificate desired

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 $58,900 to $100,100.
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 multi-line Third-Party Administrator (TPA), provides claims, risk control & loss information systems to Fortune 1000 clients across its North American platform.
ESIS provides a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products, such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management.

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.

Read the full job description and apply online on the recuiter's web-site

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