Senior Claims Specialist, Workers Comp.

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

📋 Description

• Analyze claims data and investigate routine and moderately complex workers' compensation claims.

• Assess coverage, compensability, subrogation, and benefits.

• Adjust and oversee claims within designated authority limits.

• Manage lost time and complex medical-only assignments.

• Verify and ascertain the applicability of coverage.

• Initiate contact with employers and employees within 24 hours and with attending physicians within 48 hours.

• Handle catastrophic claims with supervisory guidance.

• Conduct telephone investigations following company claims handling protocols.

• Consult with the Claim Manager when additional support is required.

• Assign claims to nurse case management and oversee billing and performance metrics.

• Set reserves for expected exposure within authority limits.

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

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

• Maintain diaries at intervals not exceeding three months.

• Document information in the claims system comprehensively.

• Review medical bills for causal relationships and appropriateness of charges, and authorize payments.

• Follow special account handling directives.

• Participate in account meetings via telephone and in person.

• Manage litigation for assigned files.

⛳️ Requirements

• Bachelor’s degree or equivalent professional experience.

• Minimum of 3 years' experience in managing workers' compensation claims.

• Proficient in California Compensation statute claims.

• Strong organizational capabilities.

• Effective time management abilities.

• Exceptional verbal and written communication skills.

• Strong proficiency and understanding of Microsoft Office applications.

• Quick learner of new software programs.

• Proficiency in foreign languages is an advantage.

• Must adhere to departmental policies and procedures, including authority levels, to align with C&F’s risk management protocols.

🏝️ Benefits

• Competitive compensation package.

• Generous employer match for 401K.

• Employee Stock Purchase plan with employer matching contributions.

• Generous Paid Time Off policy.

• Comprehensive health, dental, and vision benefits.

• Wellness programs focused on physical, mental, and financial health.

• Tuition reimbursement opportunities.

• Support for industry-related certifications.

• Professional training and development.

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

• Matching donation program.

• Volunteer opportunities available.

• Employee-driven corporate giving initiatives.