Senior Claim Representative, Worker's Compensation
- Career Level
- Not Specified
We are currently seeking a Senior Claim Representative with California designation and current California Worker's Compensation Claims experience to join our Workers Compensation Claims team. This position can sit in any of our US office locations. The Senior Claim Representative will be responsible for handling and resolving complex or specialized assigned claims through investigation, evaluation and disposition. This position will make appropriate decisions regarding coverage and settlement in addition to reviewing and processing highly complex claims.
- Makes timely and appropriate contacts, determines and completes appropriate level of investigation to make determination of coverage, assess liability and determine damages. Takes a recorded statement from all parties involved in the claim when appropriate for the type of claim being handled.
- Determines exposure, establishes adequate reserves and makes timely adjustments as required.
- Assigns and directs activities of internal and external resources as required; including independent adjusters and appraisers. Determines whether additional evidence is required including but not limited to accident reports, accident scene reconstructions, witness statements, police reports, expert opinion, etc. Identifies questionable claims and consults with SIU for further direction as appropriate.
- Determines settlement value of the loss and negotiates proper settlement of claims within authority. Provides recommendations for settlement and disposition of claims exceeding authority level.
- Documents clearly and concisely all relevant activity on assigned files and makes recommendations for additional activity as appropriate.
- Anticipates and meets all customer needs (internal and external).
- Stays abreast of state license requirements and participates in continuing education as required.
- Strong claims technical knowledge, and some legal climate background in local market or for associated line of business is essential.
- Must have proven analytical, negotiation, decision making, problem solving, organizational and presentation skills.
- Must be able to communicate professionally and effectively including strong oral, written and listening skills. Must be able to work both independently and as a member of a team and have the ability to interact with diverse groups of individuals.
- Demonstrated proficiency with computer software including Microsoft Office suite and other claims tracking systems.
- Must maintain a high level of accuracy, and provide follow-through on projects.
- Requires the ability to maintain confidential information. Must be able to work in a fast pace and rapidly changing environment.
- Bachelors degree required.
- Minimum 3-5 years of progressively complex specialty claims experience
- California Worker's Compensation Claims Experience