ESIS Claims Representative, WC

Chubb Ltd.; Dallas (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Chubb External is seeking a skilled claims professional to investigate and manage workers' compensation claims. You will determine injury extent, reserve appropriate funds, and apply medical cost containment to control payouts.

The role requires effective communication, adherence to ESIS standards, and proactive problem-solving to conclude cases. You will handle multiple priorities across various systems, documenting all activities in the ESIS claim system.

Qualifications

• Handle multiple demands and priorities from a variety of sources.
• Adjust claims with the ability to follow company policies and procedures.
• Manage a workers compensation pending independently.
• Communicate effectively in writing and orally.
• Document ESIS claim system promptly and accurately.

Responsibilities

• Investigate claims to determine extent of injury and reserve.
• Review status of claims and develop strategies to conclude.
• Utilize medical cost containment measures to control loss payouts.
• Maintain ESIS standards and best practices.
• Escalate issues and follow through to resolution.
• Handle multiple computer applications and vendor systems to manage caseloads.
• Identify and determine financial exposures and establish accurate reserves.

Skills

Customer service

Multitasking

Communication

Problem solving

Detail oriented

Tools

ESIS systems

Vendor systems

Job description

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.

MAJOR DUTIES & RESPONSIBILITIES:

• Handle multiple demands & priorities, from a variety of sources, simultaneously
• Maintain ESIS Standards & Best Practices
• Adjust claims with the ability to follow company policies and procedures
• Have the ability to effectively and independently manage and maintain a workers compensation pending.
• Handle and resolve conflict effectively
• Meet goals & objectives established by ESIS and the Claims Vice President
• Escalate issues appropriately and follow through
• Be a problem solver with excellent problem resolution skills
• Meet and maintain customer service requirements and have the ability to follow ESIS processes.
• Make sound judgment decisions and have the ability to differentiate information.
• Communicate effectively both written & orally
• Respond to customers appropriately, timely & accurately
• Ability to remain calm and professional during peak periods of activity.
• Handle multiple computer applications and vendor systems to manage caseloads
• Identify and determine short term and long term financial exposures and establish accurate financial reserves to meet Client, ESIS and Carrier expectations
• Effectively and accurately manage large sums of client or carrier funds
• Comply with all statutory reporting and licensing requirements for multiple jurisdictions
• Determine, calculate and issue accurate benefit payments to injured workers, medical providers and vendors in a timely fashion
• Clearly and concisely document the ESIS claim system with activities, investigations and plans in a timely fashion