Senior Claims Representative, WC

Responsibilities

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

Requirements

• Minimum of 3-5 years of experience handling workers' compensation claims
• Knowledge of California and/or Nevada Workers' Compensation laws
• Active adjuster license or the ability to obtain one within a specified timeframe
• Strong analytical and problem-solving abilities
• Proficiency in Microsoft Office Suite and claims management systems
• Excellent verbal and written communication skills

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 innovative risk management solutions covering both pre- and post-loss services to help create safer workplaces and support employees.