Workers Compensation Claims Specialist

Jobtailor; Brea (CA); On-site; USD 75,000 - 105,000; Full time

Job summary

Jobtailor seeks a claims professional to investigate and maintain Long Term Care claims, review coverages, determine liability, secure information and settle claims. You will coordinate investigations, negotiate complex settlement packages, and partner with attorneys, agents and experts to drive timely, cost-effective resolutions while applying strong analytical and problem‑solving skills.

Candidates should have a bachelor’s degree and 3–5 years of claims experience, plus solid knowledge of the

Qualifications

• Bachelor's degree or equivalent experience.
• Typically 3–5 years claims experience.
• Solid knowledge of claims and insurance industry theory and practices.
• Demonstrated technical expertise and product specific knowledge.
• Strong analytical and problem solving skills enabling viable alternative solutions.
• Solid knowledge of Microsoft Office Suite as well as other business-related software.

Responsibilities

• Investigates and maintains Long Term Care claims.
• Reviews coverages, determines liability and compensability, secures information, and negotiates and settles claims.
• Coordinates and performs investigations and evaluates claims and suits through contact with insureds, claimants, business partners, witnesses and experts.
• Utilizes negotiation skills to develop complex settlement packages.
• Partners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims.

Skills

Analytical thinking

Problem solving

Negotiation

Education

Bachelor's degree

Tools

Microsoft Office Suite

Job description

Responsibilities

• Investigates and maintains Long Term Care claims
• Reviews coverages, determines liability and compensability, secures information, and negotiates and settles claims
• Coordinates and performs investigations and evaluates claims and suits through contact with insureds, claimants, business partners, witnesses and experts
• Utilizes negotiation skills to develop complex settlement packages
• Partners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims

Requirements

• Bachelor's degree or equivalent experience
• Typically a minimum three to five years claims experience
• Solid knowledge of claims and insurance industry theory and practices
• Demonstrated technical expertise and product specific knowledge
• Strong analytical and problem solving skills enabling viable alternative solutions
• Solid knowledge of Microsoft Office Suite as well as other business-related software

Certifications & Qualifications

• Bachelor's degree