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Fraud Claims Operations Representative Jobs in Virginia

Chubb

ESIS Claims Representative, WC

Glen Allen, VA · On-site

$62K - $81K/yr

ESIS is seeking an experienced Workers' Compensation Claims Representative for the Glen Allen, VA ... With operations in 54 countries, Chubb provides commercial and personal property and casualty ...

Markel International

Claims Examiner

Richmond, VA · On-site +1

$62K - $85K/yr

Identifies subrogation opportunities and fraud potential and makes appropriate referrals * Strong ... operations around the world. We're all about people | We win together | We strive for better We ...

Markel Corporation

Claims Examiner

Richmond, VA · On-site

$62K - $85K/yr

Identifies subrogation opportunities and fraud potential and makes appropriate referrals * Strong ... operations around the world. We're all about people | We win together | We strive for better We ...

Markel Corporation

Associate Claims Examiner

Richmond, VA · On-site

$27.84 - $38.27/hr

Identifies subrogation opportunities and fraud potential and makes appropriate referrals * Strong ... employees with operational considerations and regulatory/ governmental requirements and ...

Crawford and Company

Claims Specialist-WC

Fairfax, VA · On-site

$16.10 - $29.44/hr

Evaluates medical claims for potential fraud issues, loss control and recovery in accordance with ... Competitive base pay - The Pay Range/Salary represents the anticipated low and high pay that may be ...

Dollar Tree

Director, Claims Litigation

Chesapeake, VA · On-site

... within business operations. This position will develop and execute litigation claim management ... Provide approval authority to TPA representatives for settlement of cases and approve increases in ...

Truist

ORMP Risk Officer II - Fraud

Richmond, VA · On-site

... Operational Risk Management Programs Risk Officer II-Fraud is a senior subject matter expert ... The requirements listed below are representative of the knowledge, skill and/or ability required.

Dollartree

Director, Claims Litigation

Chesapeake, VA · On-site

... within business operations. This position will develop and execute litigation claim management ... Provide approval authority to TPA representatives for settlement of cases and approve increases in ...

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Fraud Claims Operations Representative information

What are the key skills and qualifications needed to thrive as a fraud claims operations representative, and why are they important?

To thrive as a Fraud Claims Operations Representative, you need strong analytical skills, attention to detail, and experience in financial services or fraud investigation, often supported by a relevant associate's or bachelor's degree. Familiarity with fraud detection software, case management systems, and banking platforms is typically required. Excellent communication, problem-solving, and customer service skills help you resolve claims efficiently and reassure affected clients. These skills are essential for accurately identifying fraudulent activity, mitigating losses, and maintaining customer trust in financial institutions.

How does a fraud claims operations representative typically collaborate with other departments during an investigation?

Fraud Claims Operations Representatives regularly work with teams such as Customer Service, Risk Management, and IT Security to thoroughly investigate and resolve fraud cases. Collaboration often involves sharing detailed case information, coordinating on account holds or restrictions, and ensuring that customers are kept informed throughout the process. Effective communication and teamwork are essential, as representatives must often escalate complex cases or seek specialized expertise from other departments to reach a resolution promptly.

What does a fraud claims operations representative do?

A Fraud Claims Operations Representative is responsible for investigating and resolving claims related to fraudulent activities on customer accounts. They review transaction details, communicate with customers to gather information, and determine the validity of reported fraud. Their work helps protect both the financial institution and its customers from financial losses due to unauthorized or suspicious activity. They also ensure compliance with company policies and legal regulations during the claims process.
What are popular job titles related to Fraud Claims Operations Representative jobs in Virginia? For Fraud Claims Operations Representative jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Fraud Claims Operations Representative jobs in Virginia look for? The top searched job categories for Fraud Claims Operations Representative jobs in Virginia are:
What cities in Virginia are hiring for Fraud Claims Operations Representative jobs? Cities in Virginia with the most Fraud Claims Operations Representative job openings:
Fraud Claims Operations Representative jobs near you
Infographic showing various Fraud Claims Operations Representative job openings in Virginia as of August 2026, with employment types broken down into 86% Full Time, 11% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution.

ESIS Senior Claims Representative, WC

Chubb

Glen Allen, VA • On-site

Full-time

Re-posted 2 days ago

Chubb rating

8.2

Company rating: 8.2 out of 10

Based on 66 frontline employees who took The Breakroom Quiz

141st of 304 rated insurance

Job description


ESIS Senior Claims Representative, WC
Description
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!
The Workers' Compensation Senior Claims Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.
Duties may 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.
  • 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 and timely issues indemnity benefits if due and owing.
  • Informs claimants, insureds/customers, or attorney of denial of claim when applicable.
  • May assist Team Leader and company attorneys in preparing cases for trial by taking statements. Continues efforts to settle claims before trial.
  • Refers claims to subrogation as appropriate.
  • May participate in claim file reviews and audits with customer/insured and broker. Administers Workers' Compensation benefits timely and appropriately per Jurisdiction. Maintains control of claim's resolution process to minimize current exposure and future risks
  • Establishes and maintains strong customer relations

OTHER DUTIES MAY INCLUDE:
  • Working all queues and diary in a timely manner
  • Investigating compensability and benefit entitlement
  • Reviewing and approving medical bill payments
  • Managing vocational rehabilitation

Qualifications
  • 3-5 years' experience handling Workers' Compensation claims
  • Knowledge of claims handling and familiarity with claims terminologies
  • Effective negotiation skills
  • Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc. in a positive manner concerning losses.
  • Ability to self-motivate and work independently, excels in organization and time management skills
  • Knowledge of company products, services, coverages, and policy limits, along with awareness of the company's claims best practices and client service instructions
  • Knowledge of applicable state and local laws.
  • Experience in any of the jurisdictions serviced in the region (MD, DC, VA, NC, SC, TN, KY, WVA, OH, IN, MI) is preferred but not required.
  • 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 multi-line Third-Party Administrator (TPA), provides claims, risk control & loss information systems to Fortune 1000 clients across its North American platform. ESIS provides a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products, such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management.
About Us
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. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.

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About Chubb

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Chubb is the world's largest publicly traded property and casualty insurer. 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. We are a unique global organization with a culture of individuals passionately committed to our respective crafts. With underwriting at our core, each of us contributes to providing the best insurance coverage and service to our clients. Our highly collaborative, inclusive nature helps us drive better business outcomes through diversity of background, experiences, insights and values.

Industry

Insurance services

Company size

10,000+ Employees

Headquarters location

Warren, NJ, US

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