Hybrid Workers' Comp Claims Specialist

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

Benefits offered by this job

Medical Insurance

Dental & Vision

FSA

Parental Leave

Life & Disability Insurance

401(k) + ESPP

Education Reimbursement

Paid Leave

Holidays & Personal Days

EAP

Job summary

Zenith Insurance Company in California seeks a Workers' Compensation Claims Adjuster to investigate liability, interview medical staff, and process benefit payments within approved limits. You will evaluate claims, coordinate with claimants and providers, and support effective settlement decisions.

You will open new claims, set reserves, document thoroughly, and pursue settlements with injured workers and attorneys while maintaining data integrity.

Qualifications

• Basic technical workers' compensation Claims knowledge.
• Strong verbal and written communication skills with emphasis on telephone communication required.
• Strong math and reading skills required.
• Meets all state regulatory standards regarding licensing, continuing education, and other requirements.

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

Workers' Comp claims knowledge

Verbal and written communication

Math skills

Reading skills

Education

High School Diploma

Bachelor’s degree preferred

Self-insured designation preferred

CA hours up to date

Job description

Zenith Insurance Company in California seeks a Workers' Compensation Claims Adjuster to investigate liability, interview medical staff, and process benefit payments within approved limits. You will evaluate claims, coordinate with claimants and providers, and support effective settlement decisions.

You will open new claims, set reserves, document thoroughly, and pursue settlements with injured workers and attorneys while maintaining data integrity.