Workers' Comp Claims Specialist- California

Zenith Insurance Company; United States; Hybrid; USD 78,000 - 106,000; Full time

Benefits offered by this job

Medical/Dental/Vision

FSAs

Parental Leave

Life/AD&D/Disability Insurance

401(k) + ESPP

Education Reimbursement

Paid Vacation/Sick Leave

Holidays & Personal Days

Employee Assistance Program

Job summary

Zenith Insurance Company is seeking a Claims Examiner to evaluate workers' compensation claims, determine liability, and negotiate settlements with claimants and attorneys. You will interview claimants, medical professionals, and witnesses, and set reserves with documentation to support timely resolutions.

The role requires 3+ years WC claim experience, strong communication skills, and compliance with licensing requirements.

Qualifications

• 3+ years Workers' Comp claim or insurance experience required.
• Bilingual Spanish is a plus.
• Strong verbal and written communication with emphasis on telephone contact.
• Meets licensing and continuing education requirements as applicable.

Responsibilities

• Opens new claims, conducts investigations, and determines compensability.
• Sets reserves and monitors reserve accuracy throughout the life of the claim.
• Negotiates settlements with injured workers or attorneys within authority.
• Maintains regular contact with injured workers, employers and agents.
• Prepare detailed settlement evaluations and communicate case status.

Skills

Verbal communication

Written communication

Math skills

Regulatory compliance

Education

High School Diploma or equivalent

Bachelor’s Degree or equivalent

Self-insured designation

CA hours up to date

Job description

Introduction

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.

To support our hybrid work environment, candidates must be located near and able to commute to one of Zenith's California offices in Fresno, Woodland Hills, San Diego, Roseville, Dublin, or Orange on designated in-office days.

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 technical direction, works within significant limits and authority on assignments of higher technical complexity and coordination.
• Responsible for Claims management of assigned cases 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.

Education

• High School Diploma Or equivalent combination of training/experience required.
• Bachelor’s Degree or equivalent combination of training/experience preferred
• Self-insured designation preferred
• CA hours must be up to date

Work Experience

• 3+ years Workers' Comp claim or insurance experience required.
• Bilingual Spanish is a plus

Knowledge, Skills, and Abilities

• Basic 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 $78,101.39 - $105,762.30 . 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.Benefits

• Medical, Dental and Vision Insurance
• Flexible Spending Accounts
• Paid Parental Leave
• Life, AD&D and Disability Insurance
• 401(k), Employee Share Purchase Plan (ESPP)
• Education and Training Reimbursement
• Paid Leave: 3 weeks/year Vacation, 2 weeks/year Sick Leave
• 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 typically posts jobs for a minimum of 8 to 14 calendar days. 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.