ESIS Senior Claims Representative, WC (New Mexico Claims)

(Focus on New Mexico Claims)

Are you ready to make a meaningful impact in the world of workers' compensation? 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. At ESIS, we’re dedicated to providing exceptional service and innovative solutions, and we’re looking for passionate individuals to be part of our dynamic team. If you’re eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere!

Under the direction of the Claims Team Leader, the ESIS Senior Claim Representative investigates and resolves claims promptly, equitably, and in accordance with established best practice guidelines.

This is a hybrid position, with three days per week in-office.

Key Responsibilities:

• Claims Management: Investigate, evaluate, and manage workers' compensation claims from initiation to resolution, ensuring compliance with relevant laws, regulations, and company policies. Responsible for handling complex and intricate claims that require advanced expertise.
• Communication: Serve as the primary point of contact for injured workers, employers, medical providers, and other stakeholders, delivering clear and professional communication throughout the claims process.
• Investigation: Conduct thorough investigations by 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 case facts and applicable laws.
• Documentation: Maintain detailed and organized claim files, documenting all activities, communications, and decisions within 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 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.

• Experience: Minimum of 5–7 years managing workers' compensation claims; experience with ESIS or similar third-party administrators is preferred.
• Knowledge & Licensing: Understanding of Pennsylvania Workers’ Compensation regulations and an active adjuster license, or the ability to obtain licensure within a specified timeframe.
• Skills:
  • Strong analytical and problem-solving skills
  • Excellent verbal and written communication abilities
  • Proficiency with claims management systems and Microsoft Office Suite
  • Effective at managing multiple priorities and meeting deadlines in a fast-paced environment
• Expertise: Familiarity with workers' compensation laws, medical terminology, and best practices in claim handling. Senior Claim Representatives are expected to manage more complex and intricate claims, requiring advanced skills.

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.

The pay range for the role is $71,000 to $104,000. The specific offer will depend on an applicant’s skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program.  Chubb offers a comprehensive benefits package, more details on which can be found on our careers website.  The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.

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. With more than 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.