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Esis Claims Representative, Wc

3 months ago

Chatsworth, United States Combined Insurance Full time

ESIS®, Inc., 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. With 70 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industry’s broadest selections of risk management solutions covering both pre and post-loss services.

The ESIS Senior Workers' Compensation Claims Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.

Note: This is a hybrid position requiring 3 days in the Chatsworth office and 2 days working from home.

**Duties include but are not limited to**:

- Receive assignments.
- Reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.
- Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
- Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal.
- Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.
- Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
- Sets reserves within authority limits and recommends reserve changes to Team Leader.
- Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
- Prepares and submits to Team Leader unusual or possible undesirable exposures. Assists Team Leader in developing methods and improvements for handling claims.
- Settles claims promptly and equitably.
- Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
- Informs claimants, insureds/customers or attorney of denial of claim when applicable.
- Establishes and maintains strong customer relations
- May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial.
- Refers claims to subrogation as appropriate. May arrange for salvage disposition or other recovery proceedings as necessary by line of business.
- May participate in claim file reviews and audits with customer/insured and broker. Administers benefits timely and appropriately. Maintains control of claim’s resolution process to minimize current exposure and future risks
- May maintain system logs
- May investigate compensability and benefit entitlement
- May review and approve medical bill payments
- May manage vocational rehabilitation