Claims Operations Associate Jobs in Pennsylvania

Join ESIS, a leader in risk management and insurance services, and contribute to work that supports safer workplaces and effective claims outcomes. We are seeking a skilled and collaborative professional to help manage workers' compensation claims with accuracy, responsiveness, and a strong focus on service.

At ESIS, we value integrity, accountability, and continuous improvement. This role offers the opportunity to work in a team-oriented environment where you can apply your expertise, grow your career, and make a meaningful contribution to our clients and their employees.

Duties may include, but are not limited to:

• Receive and manage new claim assignments.
• Review claim and policy information to establish the background for investigation and determine the extent of the policy's obligations to the insured, depending on the line of business.
• Contact, interview, and obtain statements, recorded or in person, from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather necessary claim information.
• Arrange surveys and engage experts when appropriate.
• Evaluate facts obtained through investigation to determine the extent of liability, if any, and the company's obligations under the policy contract.
• Prepare reports related to investigations, settlements, claim denials, and evaluations of involved parties.
• Establish reserves within authority limits and recommend reserve changes to the Team Leader.
• Review claim progress and status with the Team Leader and discuss issues and recommended actions.
• Manage litigation files in a timely and appropriate manner.
• Assist the Team Leader in developing methods and process improvements for claims handling.
• Settle claims promptly and equitably.
• Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.
• Inform claimants, insureds, customers, agents, or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial by arranging witness attendance and obtaining statements, while continuing settlement efforts prior to trial.
• Refer claims to subrogation as appropriate.
• Participate in claim file reviews and audits with customers, insureds, and brokers as needed.
• Administer benefits in a timely and appropriate manner and maintain control of the claim resolution process to help minimize current exposure and future risk.
• Build and maintain strong working relationships with agents, underwriters, insureds, experts, and other stakeholders.

Depending on the line of business, additional duties may include:

• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments or forwarding them for outside review as needed
• Managing vocational rehabilitation

Scope Information:

This position reports directly to a Claims Team Leader or another member of claims management.

• Bachelor's degree from an accredited college or university, or equivalent work experience; advanced degree preferred.
• Strong technical knowledge of workers' compensation claims, demonstrated through claims handling experience at ESIS or a similar organization. Five or more years of claims handling experience preferred.
• Thorough knowledge of workers' compensation products, services, and coverages, along with a solid understanding of applicable legal principles. Experience in DE, NJ, NY, and/or PA preferred.
• Knowledge of workers' compensation cost containment programs and strong account management skills.
• Professional insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), AICPCU, or equivalent preferred.
• Ability to plan, organize, and implement general business and people management practices, supported by management and technical training, a business or legal college-level curriculum, or equivalent practical experience.
• Strong communication and interpersonal skills with the ability to work effectively with team members at all levels of the organization, as well as attorneys, producers, and clients.
• Understanding of team-building principles and how they apply to ongoing and planned activities.
• Ability to evaluate the effectiveness of programs and procedures and identify opportunities for improvement. Ability to facilitate and lead groups.
• Strong analytical and evaluative thinking skills, with the ability to gather and assess information from multiple sources to support sound decision-making.
• Demonstrated professionalism, credibility, and commitment to organizational strategies and values.
• Creativity, initiative, and self-motivation demonstrated through direct claim handling and related responsibilities.
• Ability to manage priorities and allocate resources effectively in support of timely, high-quality service and long-term claims handling objectives.

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.

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.

The pay range for the role is $78,100 to $109,400. 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.