Claims Representative, WC

Responsibilities

• Investigate, evaluate, and manage workers' compensation claims from inception to resolution
• Serve as the primary point of contact for injured workers, employers, and medical providers
• Conduct thorough investigations by gathering statements, reviewing medical records, and analyzing accident reports
• Make timely decisions regarding claim acceptance, denial, or settlement based on facts and applicable laws
• Maintain detailed and organized claim files within the claims management system
• Monitor and manage claim costs, including medical expenses and indemnity payments
• Ensure strict adherence to state-specific workers' compensation laws and regulations
• Collaborate with internal legal, medical, and risk management professionals to achieve optimal outcomes

Requirements

• Bachelor's degree or equivalent professional experience
• An applicable resident or designated home state adjuster's license (required)
• Proficiency in Microsoft Office Suite
• Proficiency in claims management systems
• Strong analytical, problem-solving, and organizational skills
• Excellent written and verbal communication skills

Preferred Qualifications

• Minimum of 2 years of experience handling workers' compensation claims in California
• Prior experience at ESIS or a similar third-party administrator (TPA)
• Strong familiarity with medical terminology and workers' compensation best practices

About the Company

ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. With more than 70 years of experience, ESIS offers industry-leading risk management solutions covering both pre- and post-loss services. We are dedicated to providing exceptional service and innovative solutions to help create safer workplaces.