ESIS Claims Representative, WC

Chubb Ltd.; Philadelphia, Northern (Philadelphia County, KY); Hybrid; USD 52,000 - 68,000; Full time

Job summary

ESIS Claims Representative, WC at Chubb Ltd. Under direct supervision initially, this role trains in customer service and claims functions while gaining exposure to all facets of a professional claims representative role.

As training progresses, you will be assigned a caseload and grow responsibilities, including investigation, documentation, cost control, and compliance, with collaboration across legal, medical, and risk teams.

Qualifications

• Gives exposure to professional claims work through classroom and hands-on learning.
• Under direct supervision initially, training to become a claims representative.
• Will be assigned a caseload as training progresses.

Responsibilities

• Investigate, evaluate, and manage workers’ compensation claims from inception to resolution.
• Serve as the primary contact for injured workers, employers, and medical providers.
• Conduct investigations, review medical records, and analyze reports to determine liability.
• Make timely decisions on claim acceptance, denial, or settlement.
• Maintain detailed claim files and document activities in the system.
• Monitor claim costs and reserves; comply with state laws and regulations.
• Provide timely updates and collaborate with internal teams to achieve favorable outcomes.

Skills

Customer service

Claims management

Investigation

Communication

Documentation

Cost control

Compliance

Collaboration

Job description

ESIS Claims Representative, WC

Under direct supervision initially, performs customer service and claims functions while training to become a claims representative. Gains exposure to all facets of a professional claims representative role through classroom and hands-on learning. As training progresses, will be assigned a caseload.

Duties may include, but are not limited to:

• Claims Management: Investigate, evaluate, and manage workers’ compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
• Communication: Serve as the primary point of contact for injured workers, employers, medical providers, and other stakeholders, providing clear and professional communication throughout the claims process.
• Investigation: Conduct thorough investigations of claims, including gathering statements, reviewing medical records, and analyzing accident reports to determine compensability and liability.
• Decision-Making: Make timely and accurate decisions regarding claim acceptance, denial, or settlement based on the facts of the case and applicable laws.
• Documentation: Maintain detailed and organized claim files, documenting all activities, communications, and decisions in the claims management system.
• Cost Control: Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while ensuring appropriate reserves are established and maintained.
• Compliance: Ensure adherence to state-specific workers’ compensation laws, regulations, and reporting requirements.
• Customer Service: Provide exceptional service to clients by addressing inquiries, resolving issues, and delivering timely updates on claim status.
• Collaboration: Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.