ESIS\u00AE, Inc., a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS\u2019 innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients\u2019 unique risk management needs. With more than 60 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industry\u2019s broadest selections of risk management solutions covering both pre and post-loss services.

Scope

Supervises a team of medical claims analysts (MCA) performing customer service and/or claims processing functions.\u00A0 Medical only claims are assigned to MCA based on jurisdiction and/or account.

Responsibilities

Duties may include but are not limited to:

\u2022Review accuracy of information on new claims submitted when warranted

\u2022Review claim processing work performed by MCA & provide direction for next steps as needed

\u2022Review payments processed by MCA as required

\u2022Review medical only claims processed by MCA when appropriate to ensure that:

\u25E6computer system has been checked/documented for prior claims

\u25E6that Official Disability Guidelines (ODG) have been referenced & documented with clinical information

\u25E6that specific account service instructions have been reviewed/followed & documented

\u25E6that a Claim Strategy Summary (CSS) has been documented on file to include an overview & specific plan of action

\u25E6that appropriate/timely contacts have been made with the employer, employee & medical provider as warranted

\u25E6that task specific diaries are set to drive claim activities

\u25E6to ensure that MCA is communicating with triage nurse if warranted

\u25E6to ensure that MCA completes EDI transmissions & state forms as required

\u25E6reviews all claim conversions prior to a medical only claim transfer to a field office for handling based on specific conversion criteria

\u25E6completes a specific number of quality reviews (QR\u2019s) on each MCA supervised in the team each month

\u25E6completes annual performance reviews on all team members

\u25E6ensure state licensing requirements are current with both supervisor and staff in jurisdictions where required

\u25E6ensure that MCA is utilizing ESIS preferred vendors to control claim costs

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Qualifications

\u2022Minimum 5 years of claim handling experience

\u2022Strong customer service skills

\u2022Excellent oral & written communication skills

\u2022Thorough knowledge of ESIS products, services & experience within a TPA environment

\u2022Strong leadership skills including the ability to coach, develop & lead team towards successful attainment of goals & objectives

\u2022Ability to demonstrate an understanding of team building theory & the techniques of continuous quality improvement & how they apply to ongoing activities.

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Chubb strives to offer a diverse and inclusive and rewarding work environment.\u00A0 Teamwork and mutual respect are central to how Chubb operates and we believe the best solutions draw upon diverse perspectives, experiences and skills.\u00A0 We operate in such a way where everyone, regardless of their singular background has the opportunity to contribute to our collective success.

Chubb offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, a generous retirement savings plan, disability coverage, stock purchase plan, flexible spending accounts, tuition reimbursement, and business casual dress.\u00A0 At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it.\u00A0 Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religion, age, sex, sexual orientation, transgender, national origin, disability, genetic information, veteran, or marital status, or any other characteristic protected by law.

EEO Statement

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.\u00A0 Chubb prohibits all unlawful discrimination, harassment and retaliationagainst any individual who reports discrimination or harassment.\u00A0