ESIS Senior Claims Representative, WC (Hybrid)

ESIS®, Inc., 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 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.

ESIS is seeking an experienced workers compensation Claims Representative. The person in this role will handle and maintain workers’ compensation claims and file reviews under general supervision of a supervisor and as part of the ESIS team.

Note: This is a hybrid position requiring 3 days in the Phoenix office and 2 days working from home.

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.

Duties include but are not limited to:

• Under limited supervision, receives assignments and 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.
• Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal.
• 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.