ESIS Claims Compliance Specialist, WC

The ESIS Claims Compliance Specialist Workers Compensation is responsible for minimizing penalties in Delaware New Jersey New York and Pennsylvania by ensuring compliance with initial payment requirements reviewing the causes of EDI penalties and assessing late medical payment penalties. This role also reviews state correspondence to create TNC claims for Chubb supports special projects prepares files for carrier audits provides support for open desks and offers general office assistance. The specialist implements quality plans monitors results and recommends corrective actions as needed.

This position reports to and receives direction from the Claims Manager.

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

Key responsibilities include but are not limited to:

• Reviewing the timeliness of first payments to minimize penalties.
• Reviewing unassigned PAR requests from NYS and state correspondence to ensure proper file setup.
• Preparing and reviewing files for carrier audits to ensure compliance with carrier guidelines.
• Collaborating with the Claims Manager and CVP to improve overall Quality Review (QR) scores including auditing individual files for compliance with QR guidelines.
• Participating in special projects as assigned.
• Assisting with the preparation of Claims Loss Reports (CLR).
• Completing Executive Loss Summary (ELS) reports maintaining a log of all reports due and ensuring timely compliance.
• Supporting the training of new hires and ongoing training for current employees in partnership with the Learning & Development team and in-house trainers.
• Reviewing the progress and status of claims with the Team Leader discussing issues and recommending remedial actions.
• Preparing and submitting reports on unusual or potentially undesirable exposures to the Team Leader.
• Reviewing decisions and hearing reports to ensure timely payment of awards and minimize penalties.
• Supporting the Team Leader in developing methods and improvements for claims handling.
• Assisting the Claims Vice President Claims Manager Team Leaders and Claims Handlers with special projects including reserve analysis account-specific projects closing projects and audits..

• Minimum of five years experience managing workers compensation claims demonstrated through progressive responsibility within the company or a comparable organization.
• Proven ability to work independently with minimal supervision.
• Strong organizational skills and a demonstrated ability to meet deadlines.
• Comprehensive technical knowledge of claims handling processes and related terminology.
• Excellent communication and interpersonal skills with the ability to build positive relationships with claimants customers insureds brokers and attorneys.
• Thorough understanding of company products services coverages policy limits and claims best practices.
• In-depth knowledge of applicable state and local laws relevant to the business line.
• Commitment to delivering superior customer service.
• Familiarity with workers compensation laws and regulations in Delaware New Jersey New York and Pennsylvania.

An applicable resident or designated home state adjusters license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESISs 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 $71000 to $104000. The specific offer will depend on an applicants 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 foundon 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 industrys broadest selections of risk management solutions covering both pre- and post-loss services.