Senior Claim Specialist

Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need. Hit Apply below to send your application for consideration Ensure that your CV is up to date, and that you have read the job specs first.
As an ESIS Claims Specialist, your primary responsibility will be to investigate and resolve claims efficiently and fairly under the guidance of the Claims Team Leader. Your goal is to ensure that all claims are processed in accordance with established best practices, while delivering exceptional service to our clients.
As a Claims Specialist, your duties will encompass the following responsibilities (but are not limited to):
Claim Assignment and Review: Promptly receive and review new assignments, analyzing claim and policy information to set the foundation for thorough investigations, while assessing the policy’s obligations based on the specific line of business.
Conduct in-depth interviews and secure statements (both recorded and in-person) from insured parties, claimants, witnesses, healthcare providers, legal representatives, and law enforcement to collect essential claim information.
Expert Coordination: Collaborate with experts and arrange for surveys when necessary to support claims investigations.
Liability Evaluation: Assess the facts obtained during investigations to determine the insured's liability, if applicable, and the extent of the company’s obligations under the policy contract.
Prepare comprehensive reports that encompass investigation findings, claim settlements, denials, and evaluations of involved parties to maintain accurate and current records.
Reserve Management: Set reserves within your authority limits and recommend changes to reserves to the Claims Team Leader as appropriate.
Claims Progress Review: Regularly discuss the status and progress of claims with the Claims Team Leader, addressing any challenges and proposing solutions.
Litigation Management: Oversee litigation files proactively to ensure timely and appropriate management, while striving to settle claims before progressing to trial.
Assist with Legal Preparations: Support the Team Leader and company attorneys in trial preparations by organizing witness attendance and collecting statements, while actively seeking opportunities to settle claims prior to litigation.
Identify and refer claims for subrogation as relevant to recover costs.
File Audits and Reviews: Participate in claim file reviews and audits alongside customers, insured parties, and brokers to ensure compliance and accuracy.
Timely Benefits Administration: Administer benefits promptly and fairly, while maintaining control of the claims resolution process to mitigate risk and exposure.
Customer Relationship Management: Establish and uphold strong relationships with all stakeholders, including agents, underwriters, insured parties, and industry experts, to enhance customer satisfaction.
Review and authorize medical bill payments or coordinate external assessments as necessary.
Scope of Position: This position reports directly to a Claims Team Leader or another member of the claims management team, offering opportunities for collaboration and professional growth within our dynamic environment.
A bachelor’s degree in a relevant field or comparable work experience, with additional qualifications (e.g., MBA) being a valuable asset.
Extensive Claims Expertise: A minimum of 5 years of proven experience in claims handling, preferably within ESIS or a similar organization. Expertise in Workers' Compensation claims is essential, demonstrating thorough technical knowledge and competence.
Comprehensive Understanding of Products: In-depth knowledge of Workers' Compensation products, services, coverages, and relevant legal principles that govern them.
Cost Containment Proficiency: Familiarity with Workers' Compensation cost containment strategies and a track record of effective account management are crucial for this role.
Relevant insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), or AICPCU are highly desirable and reflect commitment to professional development.
This should be evidenced through successful completion of management or technical programs or equivalent practical work experience.
Team Building Experience: Demonstrated understanding of team dynamics and the application of team-building principles in both ongoing and planned activities.
Evaluative and Critical Thinking: Strong evaluative thinking abilities, adept at sourcing and analyzing multiple data points to make informed conclusions and determine actionable strategies.
Personal Effectiveness: Evidence of cultivating personal effectiveness through confidence, credibility, and a commitment to the organization's established strategies and values.
A proactive approach to work, showcasing creativity and self-motivation in claims handling and related functions, driving engagement and improvement.
Demonstrated capability to manage activities and resource allocation effectively, prioritizing timely, high-quality service alongside long-term benefits related to claims processing.
An applicable resident or designated home state adjuster’s license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS’s employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.
Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS’ innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients’ unique risk management needs. S. and globally, ESIS provides one of the industry’s broadest selections of risk management solutions covering both pre- and post-loss services.
Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.

At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees.