Hybrid CA Workers' Comp Claims Specialist

Zenith Insurance Company (United States); Orange (CA); Hybrid; USD 78,000 - 106,000; Full time

Benefits offered by this job

Medical, Dental and Vision Insurance

Flexible Spending Accounts

Life, AD&D and Disability Insurance

401(k), ESPP

Education and Training Reimbursement

Paid Holidays, Personal Days, and Floa

Job summary

Zenith Insurance Company is seeking a claims professional to investigate, analyze, and determine liability in Workers' Compensation cases, aiming for settlement with claimants. You will interview medical professionals, agents, witnesses, and claimants to gather information and decide on benefit payments within policy guidelines.

With 3+ years of WC claims experience and strong communication and math skills, you will open cases, set reserves, perform settlement evaluations, negotiate with injured

Qualifications

• High School Diploma or equivalent required.
• Bachelor’s Degree or equivalent combination of training/experience preferred.
• Self-insured designation preferred.
• CA hours must be up to date.
• 3+ years Workers' Comp claim or insurance experience required.
• Bilingual Spanish is a plus.

Responsibilities

• Under technical direction, works within significant limits and authority on assignments of higher technical complexity and coordination.
• Responsible for Claims management of assigned cases within guidelines of published performance standards.
• Opens new Claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and/or Zenith’s timeframes and guidelines.
• Sets appropriate reserves according to Zenith’s timeframes and guidelines.
• Follows appropriate procedures for system documentation to preserve data integrity.
• Monitors and maintains accuracy of reserves over the life of the claim; when new information is received re-evaluates and recommends reserves according to Zenith’s standards.
• Creates and executes action plans needed to bring case to closure.
• Completes detailed settlement evaluations and recommends appropriate settlement value, within authority; negotiates claim settlements with injured workers and/or injured workers’ attorneys.
• Maintains regular contact with injured workers, employers and agents to develop positive relationships and establish credibility.
• Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
• Works productively and harmoniously with others on a consistence basis.
• Respond positively to direction and criticism of performance.
• Consistently maintain professional and appropriate demeanor.
• Perform other duties as assigned.

Skills

Communication skills

Math skills

Reading skills

Licensing knowledge

Education

High School Diploma

Bachelor’s Degree preferred

Self-insured designation preferred

CA hours up to date

Job description

Zenith Insurance Company is seeking a claims professional to investigate, analyze, and determine liability in Workers' Compensation cases, aiming for settlement with claimants. You will interview medical professionals, agents, witnesses, and claimants to gather information and decide on benefit payments within policy guidelines.

With 3+ years of WC claims experience and strong communication and math skills, you will open cases, set reserves, perform settlement evaluations, negotiate with injured