Senior Claims Specialist, CA Workers Comp, Remote

Crum & Forster; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

401K match

Stock Purchase Plan

Generous PTO

Tuition reimbursement

Career development

Job summary

Crum & Forster's Commercial Lines division seeks a claims professional to examine and adjust workers' compensation claims, applying coverage, reserving, and subrogation under supervision. You will coordinate with providers, employers, and employees to resolve complex claims and support risk management initiatives.

Candidates should have a bachelor's degree and 3+ years of workers' compensation experience, strong written and verbal communication skills, and proficiency with Microsoft Office.

Qualifications

• Bachelor’s degree or equivalent experience.
• Strong written and verbal communication skills.
• Experience handling workers’ compensation claims preferred.
• Proficiency with Microsoft Office programs.

Responsibilities

• Examine claims data and conduct investigations to determine coverage and benefits.
• Adjust and manage claims within assigned authority.
• Verify coverage and initiate contact with employers, employees and physicians.
• Coordinate return-to-work (RTW) and set target dates.
• Maintain diaries and document files in the claims system.

Skills

Organizational skills

Time management

Verbal & written communication

Microsoft Office

Foreign language a plus

Education

Bachelor's degree or equivalent experience

Tools

Microsoft Office

Job description

Crum & Forster Company Overview

Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry.

Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2025 Great Place to Work Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion.

C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: www.cfins.com.

Job Description

C&F's Commercial Lines division delivers specialized insurance solutions for mid-sized and large businesses across a broad range of commercial exposures, management liabilities, and industry segments.

Our portfolio includes tailored coverage solutions for General Liability, Commercial Auto, Workers' Compensation, Property, and Excess Liability, as well as Financial Lines products such as Management Liability, Professional Liability, Cyber, Crime, and Fidelity.

With more than 700 employees across the United States, Commercial Lines combines deep underwriting expertise, disciplined risk selection, and the strength of C&F's national platform. We work closely with our customers and distribution partners to provide responsive service, thoughtful risk solutions, and the confidence to navigate complex business challenges.

Examines claims data and conducts investigations into routine and moderately complex claims to determine coverage, compensability, subrogation and benefits under moderate supervisory direction. Adjusts and manages claims within the limit of assigned authority.

What you will do for C&F

• Must be well versed in California Compensation statute claims.
• Receives lost time and complex medical only assignments. Verifies and determines applicability of coverage. Initiates 24-hour contact with employer, employee and 48-hour contact with attending physician.
• Handles catastrophic claims with supervisory oversight.
• Conducts telephone investigations as required by company claims handling manual and procedures.
• Evaluates and adjusts claims within the limits of authority.
• Consults with Claim Manager on those claims where assistance and consultation is needed.
• Makes assignments to nurse case management when indicated, monitoring their billing and performance.
• Sets reserves for anticipated exposure up to authority limits.
• Completes mandatory Reserve Worksheets. Establishes reserves requiring complex analysis with lifetime pharmacy and cost inflation.
• Coordinates return to work (RTW) and sets target dates.
• Maintain diaries on maximum three (3) month intervals.
• Documents files in the claims system.
• Reviews medical bills for causal relationship, medical bill charges for appropriateness and approves payments.
• Adheres to special account handling (SHI) instructions.
• Attends account meetings by telephone and in-person.
• Manages litigation on the files.

What you will bring to C&F

• Bachelor's degree or equivalent experience.
• 3+ years of experience handling workers compensation claims.
• Strong organizational skills.
• Good time management skills.
• Foreign language communications a plus.
• Excellent verbal and written communication skills are essential.
• Strong aptitude and knowledge of Microsoft Office programs and the ability to quickly learn new programs.
• Will abide by departmental policies and procedures, including authority levels, to comply with C&F's risk management controls.

What C&F will bring to you

• Competitive compensation package
• Generous 401K employer match
• Employee Stock Purchase plan with employer matching
• Generous Paid Time Off
• Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family's wellness, including your physical, mental and financial wellbeing
• A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path
• A dynamic, ambitious, fun and exciting work environment
• We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community

At C&F you will BELONG

If you require special accommodations, please let us know. We value inclusivity and diversity. We are committed to equal employment opportu