Senior Workers' Comp Claims Specialist, CA Claims

Zenith Insurance Company (United States); San Diego (CA); On-site; USD 94,502 - 127,972; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Plan

Education and Training Reimbursement

Paid Holidays and Personal Days

Employee Assistance Program

Job summary

Zenith Insurance Company is seeking a seasoned California Workers' Compensation Claims Adjuster to join our claims team. You will investigate, evaluate, and settle complex workers’ compensation claims, communicate with medical professionals, employers, and claimants, and manage reserves within approved guidelines.

The ideal candidate has CA claims certification, at least 5 years of WC claims handling, strong written and verbal skills, and a commitment to accurate data integrity and regulatory

Qualifications

• California Workers' Compensation Claims Adjuster Certification required.
• 5+ years Workers’ Compensation claims handling experience.
• Strong verbal and written communication skills.
• Meets all state regulatory standards for licensing, continuing education, and other requirements.

Responsibilities

• Investigate, analyze, and determine the extent of company liability concerning claims and settlement with claimants.
• Open new claims, perform investigations, determine compensability, and consider subrogation or apportionment per guidelines.
• Set reserves and monitor accuracy throughout the life of the claim; re-evaluate when new information is received.
• Perform detailed settlement evaluations and negotiate settlements within authority; maintain client relationships.

Education

California Workers' Compensation Claims Adjuster Certification

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.
• Perform other duties as assigned.

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&DD 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.