Senior Claims Representative – California Workers Compensation
Job Description:
- Investigate, evaluate, mitigate, and resolve an inventory of lost time and catastrophic workers’ compensation injury claims in multiple jurisdictions
- Interview injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due
- Calculate and set timely financial reserves and proactively manage reserve adequacy throughout the claim lifecycle
- Record and code injured worker demographics, job information, and accident information in the claims management system
- File necessary forms with state regulatory agencies
- Issue timely payments to injured workers, medical providers, and service vendors
- Coordinate and actively manage medical treatment to ensure timely rehabilitation
- Negotiate settlements within designated authority with injured workers and attorneys
- Serve as subject matter expert on the Workers’ Compensation Act, adjudication process, and regulatory compliance framework
- Identify and manage subrogation, Second Injury Fund, and joint coverage recovery opportunities
- Communicate claim activity and status updates to policyholders, injured workers, and other interested parties
- Notify management and develop reports for large exposure claims and comply with reinsurance reporting requirements
- Manage the claims litigation process for timely and cost-effective resolution
- Monitor managed care and investigation vendor expenses and effectiveness
- Travel periodically to hearings, conferences, and training sessions
- Attend and participate in claim file reviews with management and defense attorneys
- Coordinate and lead special projects or processes as assigned
- Assist with oversight and supervisory duties when the team supervisor is unavailable or as assigned
- Support training, staff development, and vendor management activities
- Continuously improve product and business results through innovation
Requirements:
- 3 - 5 years of experience handling workers’ compensation claims
- Excellent written and verbal communication skills
- Strong interpersonal and relationship building skills
- Exceptional time management and organization skills
- Strong analytical and critical thinking skills
- Ability to work independently and strategically problem solve
- Ability to diplomatically manage conflict
- Ability to develop relationships within the organization and work effectively across departments
- Strong discretion and integrity in dealing with highly confidential and sensitive information
- Detail oriented
- Bachelors’ degree or equivalent insurance industry work experience
- AIC, ARM, CCP, or CPCU insurance designation preferred
- Obtain and maintain adjuster license(s) in assigned jurisdictions
Benefits:
- Health insurance
- Dental insurance
- Vision insurance
- Life insurance
- Disability insurance
- Wellness benefits
- Paid time off
- 401(k) plan
- Profit-sharing plan
- Competitive compensation plan
- Robust benefits package