ESIS Senior Claims Rep. - Non Subscription

ESIS recognizes each risk management program is unique, and we are committed to providing consultative and innovative solutions to drive superior results for your program. Our culture and vision enable us to effectively operate as an extension of your risk management program, aligning combined goals to form a collaborative partnership.

We recognize our clients’ desire to do things differently, and we are confident that our integrated approach will deliver better overall results for your program. ESIS’ specialized claim intervention strategy integrates an effective deployment of resources and appropriate actions, which are essential to your program’s success

ESIS, Inc. (ESIS) provides sophisticated risk management services designed to reduce claims frequency and loss costs. ESIS, the Risk Management Services Company of Chubb, provides claims, risk control & loss information systems to Fortune 1000 accounts. ESIS employs more than 1,500 professionals in nine regional centers and 15 major claims offices, as well as local representatives in select jurisdictions. We take our fiduciary responsibilities seriously and are proud to manage over $2.5 billion of customer losses and over 320,000 new claims annually. We specialize in large accounts which have multi-state operations. For information regarding ESIS please visit www.esis.com.

Under the leadership of the Claims Vice President and/or Claims Manager, this role is responsible for the investigation, analyzing and evaluating non-subscription claims to determine if the benefits due are consistent with a client’s Work Injury Benefit Plan and or potential Employers Liability claims. Additionally, this role is to identify subrogation potential and negotiate settlements to ensure ongoing adjudication of claims within service expectations, industry and company best practices.

MAJOR DUTIES & RESPONSIBILITIES

Duties include but are not limited to:

• Review assigned client Work Injury Benefit Plans
• Promptly investigate, evaluate and manage compensability determination and recovery
• Manages the medical and Return to Work process throughout the life of the claim
• Evaluate severity of claims by reviewing medical to develop and calculate appropriate reserves and manage reserve adequacy throughout the life of the claim
• Ensure appropriate claim file documentation and coding is completed timely and accurately
• Communicate claim activity regularly to all internal and external parties including injured workers, client, providers and legal counsel as appropriate
• Prepare timely State filings within statutory guidelines
• Calculate wages and benefits owed as well as approve medical and expense payment and ensure all benefits are paid timely
• Ensure timely and cost-effective resolution by negotiating claim settlements within assigned authority limits
• Manage the Litigation process and develop litigation plans with counsel
• Coordinate vendor utilization while ensuring cost containment techniques
• Manage claim recoveries to include subrogation, Medicare offsets, etc.
• Notify management of large losses, denials, coverage disputes or other matters requiring escalation per company guidelines
• Adhere to all Best Practice Guidelines
• Perform other duties as assigned

COMPETENCIES:

• In-depth knowledge of insurance including Workers Compensation and/or Texas Non-Subscription principles and laws, recovery, offsets, deductibles, cost-containment including medical management, Social Security, and Medicare procedures.
• Excellent Customer Service
• Excellent judgement, troubleshooting and problem-solving skills
• Excellent written and verbal communication skills

• Detail oriented with the ability to handle multiple priorities while meeting deadlines
• Excellent collaboration skills working in a team environment

REQUIRED EDUCATION AND EXPERIENCE:

• A bachelor’s degree from an accredited college or university is preferred
• 5+ years of experience working with Texas Non-Subscription claims

Chubb strives to offer a diverse and inclusive and rewarding work environment. Teamwork and mutual respect are central to how Chubb operates, and we believe the best solutions draw upon diverse perspectives, experiences and skills. We operate in such a way where everyone, regardless of their singular background has the opportunity to contribute to our collective success.