Senior Claims Representative, WC

Responsibilities

• Investigate and settle workers' compensation claims promptly and equitably following established best practices.
• Review claim and policy information to determine the extent of the company's obligation to the insured.
• Conduct interviews and obtain statements from insureds, claimants, witnesses, physicians, and attorneys.
• Evaluate facts to determine liability and prepare detailed reports on investigations, settlements, and denials.
• Set and manage reserves within established authority limits and recommend changes to the Team Leader.
• Administer workers' compensation benefits timely and appropriately according to specific jurisdictions.
• Maintain strong customer relations and manage communication with claimants, brokers, and legal counsel.
• Manage vocational rehabilitation and review medical bill payments.

Requirements

• 3-5 years of experience handling Workers' Compensation claims.
• Valid resident or designated home state adjuster's license (required).
• Strong knowledge of claims handling processes and industry terminology.
• Effective negotiation and interpersonal skills for interacting with diverse stakeholders.
• Ability to work independently with strong organization and time management skills.
• Comprehensive knowledge of applicable state and local laws.

Preferred Qualifications

• Experience in any of the following jurisdictions: MD, DC, VA, NC, SC, TN, KY, WVA, OH, IN, MI.

About the Company

ESIS, a multi-line Third-Party Administrator (TPA) under the Chubb umbrella, provides sophisticated risk management services to Fortune 1000 clients across North America. We specialize in workers' compensation claims handling, casualty insurance products, and disability management, helping to create safer workplaces and support employees in need.