Senior Claims Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Analyze claims data and carry out investigations on routine and moderately complex claims.

• Assess coverage, compensability, subrogation, and benefits.

• Adjust and manage claims within the limits of assigned authority.

• Address lost time and complex medical-only assignments.

• Verify and assess the applicability of coverage.

• Initiate contact within 24 hours with both employer and employee, and within 48 hours with the attending physician.

• Manage catastrophic claims under supervisory guidance.

• Conduct telephone investigations in line with company protocols.

• Consult with the Claim Manager when needed for assistance.

• Assign claims for nurse case management and oversee billing and performance.

• Set reserves for anticipated exposure up to the limits of authority.

• Complete required Reserve Worksheets and establish reserves that necessitate complex analysis.

• Coordinate return-to-work efforts and establish target dates.

• Maintain diaries with a maximum interval of three months.

• Document files thoroughly within the claims system.

• Review medical bills for causal relationships and appropriateness, and approve payments accordingly.

• Follow specific account handling instructions.

• Participate in account meetings both via telephone and in-person.

• Manage litigation on assigned files.

⛳️ Requirements

• Bachelor’s degree or equivalent experience.

• A minimum of 3 years’ experience managing workers' compensation claims.

• Proficient knowledge of California Compensation statute claims.

• Exceptional organizational skills.

• Strong time management abilities.

• Proficiency in foreign language communication is a plus.

• Excellent verbal and written communication abilities.

• Strong aptitude and familiarity with Microsoft Office applications.

• Capability to rapidly learn new software programs.

• Ability to adhere to departmental policies and procedures, including authority limits.

• Commitment to comply with C&F’s risk management protocols.

🏝️ Benefits

• Competitive compensation package.

• Generous 401K employer match.

• Employee Stock Purchase plan with employer matching.

• Generous Paid Time Off.

• Comprehensive health, dental, and vision benefits.

• Wellness programs aimed at enhancing physical, mental, and financial wellbeing.

• Tuition reimbursement.

• Opportunities for industry-related certifications.

• Professional training initiatives.

• A dynamic, ambitious, fun, and exciting work environment.

• Matching donation program.

• Opportunities for volunteering.

• Employee-driven corporate giving program.

• Special accommodations and a commitment to an inclusive, diverse workplace.