Workers Compensation Claims Specialist II

Zurich 56 Company Ltd; California (MO); On-site; USD 66,000 - 108,000; Full time

Job summary

Zurich North America is seeking an experienced Workers' Compensation Claims Specialist II to join our litigated claims team. This remote role supports California-based candidates and requires a valid Self-Insured (SIL) license, with proven experience managing complex, litigated workers' compensation claims.

You will analyze claims, determine coverage and compensability, develop case strategy, and negotiate settlements within authority limits, while delivering customer-focused service.

Qualifications

• Bachelor degree or equivalent with experience in Claims or Insurance.
• Licenses and certifications as required by Zurich claims operations.
• Experience handling litigated workers' compensation and complex claims.

Responsibilities

• Document claims files with accurate data per best practices.
• Assess compensability and coverage; analyze relevant facts and law.
• Develop case strategy, reserve management, and escalation as needed.
• Negotiate settlements within authority limits and ensure timely resolution.
• Maintain quality standards and collaborate with stakeholders.

Skills

Analytical thinking

Verbal communication

Written communication

Problem solving

Cross-functional collaboration

Education

Bachelor's degree

Zurich Certified Insurance Apprentice

Associate degree + 3+ years experience

Zurich Claims Training Program

High School Diploma Equivalent + 5+ years

Tools

Licensing: Self-Insured (SIL)

Job description

Workers Compensation Claims Specialist II

136909

Zurich is seeking an experienced Workers' Compensation Claims Specialist II to join our dedicated litigated claims team. This remote opportunity is available to candidates based in California who possess a valid Self-Insured (SIL) License and a proven track record of managing complex, litigated Workers' Compensation claims.

The Workers Compensation Claims Specialist will handle multi-party commercial line Workman's Compensation claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.

In this role you will be responsible for:

• Document claims file by accurately capturing and updating claims data/information in compliance with best practices for worker's compensation claims of moderate to high exposure and complexity.
• Exercise judgment to determine compensability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
• Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
• Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.
• Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
• Assess damages by calculating applicable damages or range of damages allowed by law.
• Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
• Meet quality standards by following best practices

Basic Qualifications:

• Bachelor degree and 3 or more years of experience in the Claims or Insurance area OR
• Zurich Certified Insurance Apprentice, including an associate degree with 3 or more years of experience in the Claims or Insurance area. OR
• Completion of Zurich Claims Training Program and 2 or more years of experience in the Claims or Insurance area. OR
• High School Diploma Equivalent and 5 or more years of experience in the Claims or Insurance area. AND
• Must obtain and maintain required adjuster license(s)
• Knowledge of insurance regulations, markets and products

Preferred Qualifications:

• Valid California Self-Insured (SIL) License.
• 5+ years of experience handling high-exposure Workers' Compensation claims involving complex medical, legal, and indemnity issues.
• California jurisdictional experience.
• Experience in handling commercial claims for a major insurance carrier.
• Proven experience managing litigated claims, including directing defense counsel, developing litigation strategy, participating in mediations and settlement conferences, and maintaining appropriate indemnity, medical, and expense reserves.
• Experience handling claims transfers and transitions, with the ability to quickly evaluate exposure, establish action plans, and drive claims toward resolution.
• Knowledge of Owner-Controlled Insurance Programs (OCIPs), Wrap-Up programs, and construction-related claim handling.
• Strong understanding of coverage analysis, compensability determinations, reserve management, and risk transfer opportunities, including contractual liability and third-party recovery.
• Exceptional verbal and written communication skills, with the ability to explain complex claim and coverage issues to clients, customers, brokers, and other stakeholders.
• Strong analytical, critical thinking, and problem-solving skills, with the ability to evaluate exposure, interpret policy language, and identify trends.
• Demonstrated ability to manage multiple priorities, collaborate cross-functionally, and build effective working relationships to achieve optimal claim outcomes.

Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply—your unique background matters to us. The pay range shown is a national average and may vary by location. The proposedSalary range for this position is $65,900.00 - $108,000.00, with short-term incentive bonus eligibility set at 10%.

We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here .]

At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment—so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500.

Join us for a brighter future—for yourself and our customers.

Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets.

Zurich complies with 18 U.S. Code § 1033.

Location: AM - California Virtual Office

Remote Working: Yes

Schedule: Full Time

Employment Sponsorship Offered: No