Senior Workers' Comp Claims Specialist (Remote)

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

Job summary

Old Republic Commercial Risk is seeking a claims professional to independently investigate, evaluate, and resolve complex workers' compensation claims. In this remote role, you will manage high-risk cases, determine coverage, subrogation potential, and reserves while coordinating with PMA resources and third-party vendors.

The ideal candidate holds a Bachelor's degree with 4+ years in insurance, CA experience, and an AIC designation or similar is desirable.

Qualifications

• Bachelor's degree or higher required; four+ years in insurance preferred.
• California jurisdiction experience is required or strongly preferred.
• Associate in Claims (AIC) designation or similar is desirable.
• License required or ability to obtain within 90 days where mandated.
• Familiarity with medical terminology and Workers' Compensation regulations.
• Strong organization, independent work and multi-tasking abilities.
• Proven analytical thinking, sound judgment and attention to detail.
• Excellent verbal and written communication and customer service skills.

Responsibilities

• Investigate and resolve assigned claims with minimal supervision, including complex cases.
• Determine coverage, compensability and subrogation potential.
• Notify supervisor of potentially suspect claims and escalate as needed.
• Ensure timely denial or payment of benefits per jurisdictional rules.
• Establish reserves with justification and adjust as claims evolve.
• Negotiate settlements within granted authority and advocate for appropriate outcomes.
• Coordinate medical and disability management, and collaborate on return-to-work strategies.
• Manage vendors to balance costs with loss outcomes and service quality.
• Communicate clearly with clients and internal/external parties throughout the claim lifecycle.

Skills

Organizational skills

Critical thinking

Communication skills

Customer service

MS Office proficiency

Education

Bachelor's degree

Four years of related experience

Tools

MS Office Suite

Job description

Old Republic Commercial Risk is seeking a claims professional to independently investigate, evaluate, and resolve complex workers' compensation claims. In this remote role, you will manage high-risk cases, determine coverage, subrogation potential, and reserves while coordinating with PMA resources and third-party vendors.

The ideal candidate holds a Bachelor's degree with 4+ years in insurance, CA experience, and an AIC designation or similar is desirable.