Senior Claims Specialist – Workers' Compensation

This is a fully remote position, open to applicants in California, +1 more state.

📋 Description

• Oversee workers' compensation claims in California and Oregon from start to finish.

• Assess claim details and determine coverage, compensability, and eligibility for benefits.

• Formulate and implement strategies to secure timely and positive outcomes for claims.

• Set and uphold suitable reserves for claims.

• Negotiate settlements to achieve effective claim resolutions.

• Engage in regular communication with claimants, insured parties, employers, and other interested parties.

• Compile and deliver large loss reports to both internal and external stakeholders.

• Work in conjunction with defense attorneys on litigation strategies and claim resolutions.

• Collaborate with medical case managers, surveillance providers, and various external entities.

• Ensure adherence to the workers' compensation laws and regulations of Illinois.

• Keep precise and timely documentation of claims.

• Examine claim trends and exposures to facilitate informed decision-making.

• Deliver outstanding service while fostering strong relationships with clients and business partners.

⛳️ Requirements

• Typically, 10+ years of experience in adjusting workers' compensation claims, including those that are complex or high-exposure.

• Experience in California is a must.

• Experience in Oregon is preferred but not mandatory.

• In-depth understanding of California's workers' compensation laws, regulations, and claims practices.

• Familiarity with Oregon's workers' compensation laws and claims practices is advantageous.

• Professional certifications such as Associate in Claims (AIC) are preferred.

• Capability to work during Pacific Time Zone business hours.

• Willingness to travel occasionally as required.

• Superior written and verbal communication abilities.

• Aptitude for working with various internal and external contacts.

• Must possess authorization to work in the United States without the necessity for current or future sponsorship.

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Wellness plans

• Parental leave

• Adoption assistance

• Tuition reimbursement

• Paid Time Off

• Paid holidays

• 401(k) plan with company match

• Employee stock purchase plan

• Commuter benefits