Workers Compensation Claims Specialist
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The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to mild to moderately complex Workers Compensation claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with injured workers, claimants, policyholders, medical providers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.
*This is a range posting, and we may fill as an Associate Claims Specialist, Claims Specialist I, Claims Specialist II, or Senior Claims Specialist I, depending on candidate experience. The salary range is reflective of this. We are looking to fill the positions in Glendale, CA, Rocklin, CA, Los Angeles, CA metro, Orange, CA or Portland, OR.
- Manages an inventory of claims to evaluate compensability/liability.
- Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.
Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
Performs other duties as assigned.
- Bachelor's Degree or equivalent
- 1-5 years' experience in claims adjusting along with knowledge of claims investigation techniques, legal liability, insurance coverage, negotiation skills and medical terminology
- Effective written and verbal communication skills to provide information in a clear and concise manner and to communicate with a variety of individuals
- Effective analytical skills to gather information, analyze facts and make recommendations based upon information collected
- Required to obtain and maintain all applicable licenses. Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU).