Senior Workers' Comp Claims Specialist - CA Claims

Zenith Insurance Company (United States); Fresno (CA); On-site; USD 95,000 - 128,000; Full time

Benefits offered by this job

Medical, Dental and Vision Insurance

Flexible Spending Accounts

Life/AD&D/Disability Insurance

401(k)/ESPP

Education and Training Reimbursement

Holidays & Personal Days

Employee Assistance Program

Job summary

Zenith Insurance Company in California is seeking a senior Workers' Compensation Claims Adjuster to assess liability, interview medical experts, and determine settlement values within authority.

You will open new claims, set reserves, maintain data integrity, and communicate with injured workers, employers, and agents. Requires CA WC Claims Adjuster Certification, 5+ years WC claims handling, and a Bachelor's or equivalent.

Qualifications

• Must hold California Workers' Compensation Claims Adjuster Certification/ designation.
• 5+ years Workers' Compensation Claims handling experience.
• CA workers' comp claims experience is required.

Responsibilities

• Investigate and determine liability and settlement values for claims.
• Open new claims, perform investigations, and set reserves.
• Communicate with injured workers, employers, agents, and medical professionals.
• Maintain data integrity and ensure compliance with state regulations.

Skills

Verbal communication

Written communication

Numerical ability

Advanced WC knowledge

Education

High School Diploma or equivalent

Bachelor's Degree or equivalent

Tools

CA WC claims system

Job description

Zenith is a team of Workers' Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers' Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations. In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional.

Overview

Investigate, analyze, and determine the extent of company's liability concerning Claims and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of Claims within a certain monetary limit. All tasks are to be performed with the goal of demonstrating Zenith's superior Claims handling expertise.

Responsibilities

• Under limited direction, works within broad limits and authority on highly complex assignments.
• Responsible for Claims management of assigned case load 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.

Qualifications

• Must have California Workers' Compensation Claims Adjuster Certification/ designation.

Education

• High School Diploma or equivalent required
• Bachelor's Degree or equivalent required

Work Experience

• 5+ years Workers' Compensation Claims handling experience required
• CA workers Comp claims experience is a must

Knowledge, Skills, And Abilities

• Advanced 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.

Pay, Benefits, And Other Information

The expected salary range for this position is $94,502.68 - $127,972.38. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law. Qualifications may warrant placement in a different job level.

• Medical, Dental and Vision Insurance
• Flexible Spending Accounts
• Life, AD&D and Disability Insurance
• 401(k), Employee Share Purchase Plan (ESPP)
• Education and Training Reimbursement
• 10 paid Company Holidays, 2 Personal Days, 2 Floating Holidays
• Employee Assistance Program (EAP)
• For more information, review details on the Benefits page of our Career Site: https://www.thezenith.com/careers/benefits/

Zenith Insurance Company is an equal opportunity employer and considers all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristic. In compliance with California law, we are committed to fair hiring practices. Pursuant to the California Fair Chance Act (AB 1008), we will consider qualified applicants with criminal histories in a manner consistent with the law. Additionally, in accordance with the Los Angeles Fair Chance Initiative for Hiring Ordinance, we will not inquire about an applicant's criminal history until after a conditional offer of employment has been made.

If you are a qualified individual with a disability or a disabled veteran and need assistance accessing our career center or applying for a position due to your disability, you are entitled to request an accommodation. To make a request, please contact a Human resources representative at Zenith Insurance Company.