Senior Claims Specialist, CA Workers Comp

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

📋 Description

• Analyze claims data and investigate both routine and moderately complex claims.

• Assess coverage, compensability, subrogation, and benefits.

• Adjust and manage claims within designated authority limits.

• Handle lost time and complex medical-only assignments.

• Verify and determine the applicability of coverage.

• Initiate 24-hour communication with employers and employees, and 48-hour communication with attending physicians.

• Manage catastrophic claims with supervisory oversight.

• Conduct telephone investigations in accordance with claims handling procedures.

• Consult with the Claim Manager when assistance is required.

• Assign nurse case management as necessary and monitor billing and performance.

• Set reserves for anticipated exposure within authority limits.

• Complete mandatory Reserve Worksheets and establish reserves that require complex analysis.

• Coordinate return to work processes and set target dates.

• Maintain claim diaries at a maximum of three-month intervals.

• Document files accurately in the claims system.

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

• Adhere to specific account handling instructions.

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

• Manage litigation associated with claim files.

⛳️ Requirements

• Bachelor’s degree or equivalent experience required.

• Over 3 years of experience in handling workers' compensation claims.

• Proficient in California Compensation statute claims.

• Strong organizational abilities.

• Effective time management skills.

• Excellent verbal and written communication capabilities.

• Strong proficiency and knowledge of Microsoft Office programs.

• Capacity to quickly learn new software applications.

• Will adhere to departmental policies and procedures, including authority levels, to comply with risk management controls.

• Proficiency in foreign language communications is a plus.

🏝️ Benefits

• Competitive compensation package.

• Generous 401K employer match.

• Employee Stock Purchase plan with employer matching.

• Generous Paid Time Off.

• Health, dental, and vision benefits.

• Programs for physical, mental, and financial wellbeing.

• Tuition reimbursement.

• Opportunities for industry-related certifications.

• Professional training available.

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

• Matching donation program.

• Volunteer opportunities.

• Employee-driven corporate giving program.

• Equal employment opportunity and accommodations for applicants with disabilities.