Fraud Claims Operations Representative Jobs in Lancaster, SC

Are you looking to grow your career in workers' compensation and claims support? Join ESIS, a leader in risk management and insurance services, where you can help support effective claims handling and contribute to positive outcomes for employees and clients.

ESIS is seeking an experienced Workers' Compensation Claims Representative for the Glen Allen, VA office. This role is responsible for handling and maintaining workers' compensation claims and conducting file reviews under the general supervision of a manager as part of the ESIS team.

Duties and Responsibilities

• Claims Management: Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
• Communication: Act 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, including 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, 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 to clients 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 3 years of experience handling workers' compensation claims, including claims investigation and adjusting. Experience in a third-party administrator (TPA) environment is preferred.
• Knowledge & Licensing: Working knowledge of workers' compensation coverage, compensability, principles, and practices, with knowledge of workers' compensation laws and procedures in VA, WV, IN, MI, OH, NC, SC, TN, and/or KY required. Knowledge of applicable state and local regulations is also required.
• Skills:
  • Ability to work independently and manage a variety of technical subjects.
  • Ability to organize, prioritize, and complete multiple objectives effectively, with strong time management skills.
  • Strong computer skills, including Microsoft Word and Excel.
  • Ability to communicate effectively and work collaboratively with accounts, injured workers, attorneys, and colleagues.
  • Ability to determine, calculate, and issue accurate benefit payments to injured workers, medical providers, and vendors in a timely manner.
  • Ability to assist with national account coordination.
  • Ability to remain professional during periods of high activity.
  • Bachelor's degree or equivalent practical work experience.
  • AIC/CPCU designation preferred.

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 $62,700 to $81,300. 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.