Claims Specialist, Workers Compensation

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🔥 2 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $85k - $120k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👩‍👩‍👧‍👦 Human Resources (HR)

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Trucordia

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1987

💼 Consulting

⚖️ Legal

📦 Logistics

Consulting • Legal • Logistics

Trucordia is a national insurance brokerage that delivers tailored risk management and insurance solutions for both individuals and businesses. With a focus on customized coverage, they provide services in commercial and personal insurance, as well as benefits solutions. Their aim is to help clients manage risks effectively, allowing them to concentrate on what matters most.

📋 Description

• Act as the primary point of contact for clients regarding workers’ compensation claims. • Advocate for aggressive investigation of questionable claims and use of sub-rosa surveillance when appropriate. • Monitor open claims to ensure timely and appropriate handling by Carriers/TPAs. • Provide guidance on claim strategy and resolution options. • Identify opportunities for claim closure, cost containment, and fraud prevention. • Assist clients in understanding claim status, medical treatment plans, and return-to-work strategies. • Educate clients on the use of Medical Provider Networks (MPNs) and help identify quality care providers. • Work with clients and Carriers/TPAs to establish and enforce claims handling protocols. • Evaluate Carriers/TPA’s bill review and utilization review programs. • Ensure quarterly claim reviews are conducted and assist in preparing claim summaries and presentations for client meetings. • Review and analyze loss runs, claim trends, and reserve accuracy. • Prepare projected experience mods ratings and explain increases or decreases. • Stay current on legislative changes and industry trends affecting workers’ compensation.

🎯 Requirements

• Bachelor's Degree or higher is desired but not required if appropriate work experience is present • 7-10+ years CA workers’ compensation claims handling or consulting - required • SIP certificate required • Strong understanding of CA WCAB processes, reserves, litigation strategy - required • Ability to interpret loss runs, mod worksheets, and actuarial data • Excellent communication skills - both written and oral • Proficiency with Excel, Word, and RMIS platforms • The ability to be a team player and proactively support others

🏖️ Benefits

• Medical, Dental, Vision • Life Insurance and AD&D • FSA / HSA • Accident Insurance • Critical Illness Insurance • Hospital Indemnity Insurance • Supplemental Health Insurance • EAP • Pet Insurance • 11 Paid Holidays • Flexible PTO • 401K