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Crum & Forster Services India Private Limited · 2 months ago

Senior Claims Specialist - Workers Compensation - CA

Orange, CA

Full-time

Onsite

Mid, Senior Level

$56K/yr - $105K/yr

3+ years exp

Crum & Forster is a well-established insurance company providing specialty and standard commercial lines insurance products. The Senior Claims Specialist will examine claims data, conduct investigations, and manage workers' compensation claims, particularly in the California jurisdiction, ensuring compliance and effective communication with all parties involved.

Information Technology & Services

Responsibilities

Examines claims data and conducts investigations into routine and moderately complex claims to determine coverage, compensability, subrogation and benefits under moderate supervisory direction

Adjusts and manages claims within the limit of assigned authority

Must be well versed in California Compensation statute claims

Receives lost time and complex medical only assignments

Verifies and determines applicability of coverage

Initiates 24-hour contact with employer, employee and 48-hour contact with attending physician

Handles catastrophic claims with supervisory oversight

Conducts telephone investigations as required by company claims handling manual and procedures

Evaluates and adjusts claims within the limits of authority

Consults with Claim Manager on those claims where assistance and consultation is needed

Makes assignments to nurse case management when indicated, monitoring their billing and performance

Sets reserves for anticipated exposure up to authority limits

Completes mandatory Reserve Worksheets

Establishes reserves requiring complex analysis with lifetime pharmacy and cost inflation

Coordinates return to work (RTW) and sets target dates

Maintain diaries on maximum three (3) month intervals

Documents files in the claims system

Reviews medical bills for causal relationship, medical bill charges for appropriateness and approves payments

Adheres to special account handling (SHI) instructions

Attends account meetings by telephone and in-person

Manages litigation on the files

Qualification

California Workers CompensationClaims ManagementMedical Bill ReviewOrganizational SkillsForeign Language CommunicationMicrosoft OfficeVerbal CommunicationWritten CommunicationTime Management

Required

Experience with California Workers Compensation jurisdiction is required for this role

Must be well versed in California Compensation statute claims

College degree, B.A. or equivalent experience

3+ years of experience handling workers compensation claims required

Strong organizational skills

Good time management skills

Excellent verbal and written communication skills are essential

Strong aptitude and knowledge of Microsoft Office programs and the ability to quickly learn new programs

Will abide by departmental policies and procedures, including authority levels, to comply with C&F's risk management controls

Preferred

5+ years preferred

Foreign language communications a plus

Benefits

Generous 401K employer match

Employee Stock Purchase plan with employer matching

Generous Paid Time Off

Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeing

Tuition reimbursement

Industry-related certifications

Professional training

Matching donation program

Volunteer opportunities

Employee-driven corporate giving program