Senior Claims Specialist, CA Workers Comp

🔥 17 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $58.7k - $110.2k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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Crum & Forster

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🛡️ Insurance

⚕️ Healthcare Insurance

Insurance • Healthcare Insurance

Crum & Forster (C&F) is a leading national property & casualty insurance company with a large, diversified specialty platform. Established in 1822, C&F provides specialty and standard commercial lines insurance products through its admitted and surplus lines insurance companies. With a written premium of $5. 3 billion as of 2023, C&F has an A. M. Best financial strength rating of “A” (Excellent). The company prides itself on creative, flexible, and client-focused solutions, recognized for superior customer service, claims, and risk engineering services. C&F employs over 2000 people across the United States and has earned several workplace awards for its employee-first focus and commitment to diversity, equity, and inclusion. C&F is part of Fairfax Financial Holdings Limited, engaged in property and casualty insurance and reinsurance.

📋 Description

• Examine claims data and investigate routine and moderately complex claims • Determine coverage, compensability, subrogation, and benefits • Adjust and manage claims within assigned authority limits • Receive lost time and complex medical-only assignments • Verify and determine applicability of coverage • Initiate 24-hour contact with employers and employees and 48-hour contact with attending physicians • Handle catastrophic claims with supervisory oversight • Conduct telephone investigations according to claims handling procedures • Consult with the Claim Manager when assistance is needed • Assign nurse case management when indicated and monitor billing and performance • Set reserves for anticipated exposure within authority limits • Complete mandatory Reserve Worksheets and establish reserves requiring complex analysis • Coordinate return to work and set target dates • Maintain claim diaries at maximum three-month intervals • Document files in the claims system • Review medical bills for causal relationship and appropriateness and approve payments • Adhere to special account handling instructions • Attend account meetings by telephone and in person • Manage litigation on claim files

🎯 Requirements

• Bachelor’s degree or equivalent experience • 3+ years of experience handling workers compensation claims • Well versed in California Compensation statute claims • Strong organizational skills • Good time management skills • Excellent verbal and written communication skills • Strong aptitude and knowledge of Microsoft Office programs • Ability to quickly learn new programs • Will abide by departmental policies and procedures, including authority levels, to comply with risk management controls • Foreign language communications a plus

🏖️ Benefits

• Competitive compensation package • Generous 401K employer match • Employee Stock Purchase plan with employer matching • Generous Paid Time Off • Health, dental, and vision benefits • Physical, mental, and financial wellbeing programs • Tuition reimbursement • Industry-related certifications • Professional training • Dynamic, ambitious, fun and exciting work environment • Matching donation program • Volunteer opportunities • Employee-driven corporate giving program • Equal employment opportunity and accommodations for applicants with disabilities