Workers Compensation Claims Specialist II

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

📋 Description

• Manage multi-party commercial line Workers' Compensation claims that involve moderate to high exposure and complexity, adhering to specific authority limits.

• Accurately document claims files by capturing and updating claims data and information in alignment with best practices.

• Establish compensability by collecting and analyzing pertinent facts, applying relevant laws, and understanding basic principles of negligence.

• Verify policy coverage and eligibility by assessing applicable coverage and determining if the loss is covered.

• Formulate case strategies and evaluations, escalate issues as necessary, and strive for prompt claim resolution.

• Set timely reserves and perform ongoing reviews throughout the claims process within authority limits.

• Evaluate damages by calculating applicable damages or ranges permitted by law.

• Negotiate claim settlements utilizing appropriate strategies, tools, and resources within authority limits.

• Achieve quality standards by adhering to best practices.

• Provide customer-focused claims service.

⛳️ Requirements

• Bachelor’s degree and at least 3 years of experience in the Claims or Insurance field; OR Zurich Certified Insurance Apprentice, which includes an associate degree and 3 or more years of experience; OR completion of the Zurich Claims Training Program with 2 or more years of experience; OR a high school diploma or equivalent with 5 or more years of experience.

• Must secure and maintain necessary adjuster license(s).

• Proficiency in Microsoft Office.

• Understanding of insurance regulations, markets, and products.

• Preferred: Valid California Self-Insured (SIL) License.

• Preferred: 5+ years of experience managing high-exposure Workers' Compensation claims with complex medical, legal, and indemnity issues.

• Preferred: Experience in California jurisdiction.

• Preferred: Experience managing commercial claims for a major insurance carrier.

• Preferred: Experience overseeing litigated claims, including directing defense counsel, developing litigation strategies, participating in mediations and settlement conferences, and maintaining appropriate indemnity, medical, and expense reserves.

• Preferred: Experience in claims transfers and transitions.

• Preferred: Knowledge of Owner-Controlled Insurance Programs (OCIPs), Wrap-Up programs, and handling construction-related claims.

• Preferred: Strong understanding of coverage analysis, compensability determinations, reserve management, and risk transfer opportunities, including contractual liability and third-party recovery.

• Preferred: Exceptional verbal and written communication abilities.

• Preferred: Strong analytical, critical thinking, and problem-solving skills.

• Preferred: Capability to manage multiple priorities, collaborate across functions, and cultivate effective working relationships.

• No employment sponsorship is available.

🏝️ Benefits

• Eligibility for a short-term incentive bonus set at 10%.

• Competitive compensation.

• Comprehensive benefits for employees and their families.

• Opportunities for growth.

• An inclusive and supportive work environment.