ESIS Claims Compliance Specialist, WC

The ESIS Claims Compliance Specialist is responsible for ensuring compliance and supporting operational excellence within the claims department. This role involves preparing annual reports for self-insured accounts, responding to the Self-Insured Audit Committee, supporting special projects, preparing files for carrier and state audits, and providing general office support. 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.

Duties & Responsibilities include, but are not limited to:

• Prepare annual reports for self-insured accounts, including claims data and financial information, for submission to California’s DIR Office of Self-Insurance Plans (OSIP) by March 1st each year. This includes the annual report, actuarial study, and audited financials.
• Review and prepare files for PAR Audits to ensure timely and accurate payments, proper documentation, and correct wage calculations.
• Review and prepare files for Carrier Audits to ensure compliance with carrier guidelines.
• Collaborate with the Claims Manager to improve overall Quality Review (QR) scores, including auditing individual files for compliance with QR guidelines.
• Participate in special projects as assigned.
• Assist in the preparation of Claims Loss Reports (CLR).
• Complete Executive Loss Summary (ELS) reports, maintain a log of all reports due, and ensure timely compliance.
• Support the training of new hires and provide ongoing training for existing employees, working with the Learning & Development team and in-house trainers to develop training schedules.
• Review the progress and status of claims with the Team Leader, discuss issues, and recommend remedial actions.
• Prepare and submit reports on unusual or potentially undesirable exposures to the Team Leader.
• Assist in penalty reduction initiatives.
• Support the Team Leader in developing methods and improvements for claims handling.
• Assist 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, with demonstrated career progression in a similar role or organization.
• Proven ability to work independently with minimal supervision.
• Strong organizational skills with a demonstrated ability to meet deadlines.
• Advanced technical knowledge of claims handling processes and related terminology.
• Excellent communication and interpersonal skills, with the ability to interact effectively with claimants, customers, insureds, brokers, and attorneys.
• Solid understanding of company products, services, coverages, policy limits, and claims best practices.
• Comprehensive knowledge of applicable state and local laws relevant to workers’ compensation.
• Commitment to delivering high-quality customer service.
• California Certified Self-Insurance Plan (SIP) certification 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.

The pay range for the role is $78,100 to $114,400. 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.

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.