Remote Claims Specialist – Workers' Comp (Complex)

Old Republic Commercial Risk; Anaheim (CA); On-site; USD 70,000 - 85,000; Full time

Job summary

Old Republic Commercial Risk seeks an experienced claims professional to independently investigate, evaluate and resolve high-complexity Workers' Compensation claims while ensuring compliance with statutes, policy provisions and company guidelines.

Responsibilities include proactive investigation, coverage determination, reserves management, settlements, and collaboration with PMA nurses to support return-to-work plans.

Qualifications

• Bachelor's degree and/or four+ years of equivalent work experience in insurance
• California jurisdiction experience
• Associate in Claims (AIC) designation or similar designation desired
• License required or ability to obtain within 90 days
• Familiarity with medical terminology and Workers' Compensation
• Knowledge of Workers' Compensation regulations, preferably jurisdiction-specific
• Strong organizational skills with ability to multitask
• Excellent verbal and written communication and customer service skills
• MS Office proficiency (Word, Excel, PowerPoint)
• Ability to travel for business (<10%)
• Remote position

Responsibilities

• Investigate all assigned claims with minimal supervision, including complex ones
• Determine coverage, compensability, potential for subrogation, and second injury fund
• Alert Supervisor and SIU to potentially suspect claims
• Ensure timely denial or payment of benefits per jurisdictional requirements
• Establish reserves with rationale and adjust over the life of the claim
• Negotiate settlements within granted authority
• Develop action plans for resolution including medical, disability, litigation, and disposition
• Collaborate with PMA nurses to implement return-to-work strategies
• Manage service vendors to balance cost and loss outcome
• Demonstrate best claim practices and effective communication with all parties
• Provide high level of customer service during reviews and meetings
• Authorize treatment per PMA protocols and state statutes
• Suggest panel provider information to PMA clients as required

Skills

Organizational skills

Critical thinking

Verbal and written communication

Customer service

Education

Bachelor's degree

AIC designation or equivalent

Tools

Word

Excel

PowerPoint

Job description

Old Republic Commercial Risk seeks an experienced claims professional to independently investigate, evaluate and resolve high-complexity Workers' Compensation claims while ensuring compliance with statutes, policy provisions and company guidelines.

Responsibilities include proactive investigation, coverage determination, reserves management, settlements, and collaboration with PMA nurses to support return-to-work plans.