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 claimants, witnesses, physicians, attorneys, and police officers.
• Evaluate investigation facts to determine liability and prepare detailed reports on settlements, denials, and evaluations.
• Set reserves within authority limits and recommend necessary changes to the Team Leader.
• Manage claim resolution processes to minimize current exposure and future risks.
• Administer workers' compensation benefits timely and appropriately according to jurisdiction.
• Maintain strong customer relations with claimants, insureds, brokers, and attorneys.
• Perform additional duties such as reviewing medical bill payments and managing vocational rehabilitation.

Requirements

• 5-7 years of experience handling Workers' Compensation claims.
• Strong knowledge of claims handling processes and industry terminology.
• Proven effective negotiation skills.
• Excellent communication and interpersonal skills for interacting with diverse stakeholders.
• Ability to work independently with strong organization and time management skills.
• Knowledge of applicable state and local laws.
• An applicable resident or designated home state adjuster's license is required.

About the Company

ESIS, a multi-line Third-Party Administrator (TPA) under Chubb, 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 their time of need.