Sr Claims Specialist

Job Description
Overview:
Investigate, analyze, and determine the extent of company's liability concerning claims and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of claims within a certain monetary limit. All tasks are to be performed with the goal of demonstrating Zenith’s superior claims handling expertise.

Responsibilities:

The essential functions of this position include, but are not limited to, the following:

Under limited direction, works within broad limits and authority on highly complex assignments. Responsible for claims management of assigned case load within guidelines of published performance standards.

Opens new claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and/or Zenith’s timeframes and guidelines.

Sets appropriate reserves according to Zenith’s timeframes and guidelines.

Follows appropriate procedures for system documentation to preserve data integrity.

Monitors and maintains accuracy of reserves over the life of the claim; when new information is received re-evaluates and recommends reserves according to Zenith’s standards.

Creates and executes action plans needed to bring case to closure.
Completes detailed settlement evaluations and recommends appropriate settlement value, within authority; negotiates claim settlements with injured workers and/or injured workers’ attorneys.

Maintains regular contact with injured workers, employers and agents to develop positive relationships and establish credibility.

Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.Works productively and harmoniously with others on a consistence basis.

Respond positively to direction and criticism of performance.

Consistently maintain professional and appropriate demeanor.

Perform other duties as assigned.

Qualifications:

Education, Skills and Experience Requirements

Bachelor’s degree or equivalent combination of training/experience required.

Minimum of (5) year’s workers’ compensation claims handling experience required.

Meets all state regulatory standards regarding licensing, continuing education, and other requirements.

Advanced technical workers’ compensation claims knowledge.

Strong verbal and written communication skills with emphasis on telephone communication required.

Strong math and reading skills required.

Bilingual English/Spanish

Attendance Requirements

Due to the nature of the needs in the office, regular and reliable attendance is required. Must be able to work at least 37.5 hours per week, Monday through Friday, and be available as situations arise requiring extended hours.

Company

Zenith Insurance Company

Job Code

State or Province

California

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