Senior Claims Specialist - California Workers Compensation (Remote)

Responsibilities

• Handle some of our highest exposure and most complex workers’ compensation claims in assigned jurisdictions.
• Serve as a Subject Matter Expert (SME) for all technical claims handling activities, including regulatory compliance.
• Assume full responsibility of claims related account management activities for large clients.
• Lead special projects and programs, and lead claims related account management activities for large clients.
• Actively work with Business Development and Underwriting teams to monitor loss ratio for assigned accounts.
• Participate in client meetings for training on claims issues and assist with claims service meetings for new accounts as requested.
• Effectively investigate, evaluate, mitigate and resolve a pending inventory of litigated and high exposure workers’ compensation claims within delegated authority and in accordance with performance standards.
• Promptly notify claims management of high-exposure claims and assist in compliance with reinsurance reporting requirements.
• Actively work with key internal & external business partners and vendors to develop, maintain, and improve partnerships and programs.
• Maintain and demonstrate high-level of knowledge of the Workers Compensation Act and Rules and Regulations in assigned jurisdictions.
• Actively participate in the training and development of claims adjusters through mentoring and conducting training for new hires and existing staff.
• Identify and address areas for coaching and training needs of claims adjusters and communicate needs with claims management and assist in development of action plans for improvement.
• Coordinate relevant legal training seminars for claims staff in assigned jurisdictions.
• Visibly support the overall claims adjusting and managed care functions in assigned jurisdictions.
• Absorb and research jurisdictional case law and statutory legal trends.
• Communicate case and statutory law and legal trends that impact claims handling.
• Display tact and discretion in all communications and provide a positive contribution to the morale of the claims department.
• Lead special projects as assigned by senior claims management.
• Continuously strive to improve our product and business results through innovation.

Qualifications

• Minimum of 7-9 years of technical claims handling experience with a heavy emphasis on workers’ compensation claims in multiple jurisdictions.
• Supervisory experience a plus, but not required.
• Consistently display a high-level of ownership, drive, and accountability.
• Acts as an informal leader.
• Excellent written, verbal, interpersonal, and relationship building skills.
• Exceptional time management and organization skills.
• Strong insurance business acumen and leadership skills.
• Ability to work independently and strategically problem solve.
• Strong analytical and critical thinking skills.
• Ability to diplomatically manage conflict.
• To work effectively across departments.
• Strong discretion and integrity in dealing with highly confidential and sensitive information.
• Display a high-degree of attention to detail.