Senior Claims Specialist, Workers Compensation - Remote

About the role

Crum & Forster provides property & casualty, accident & health, specialty and standard commercial lines insurance solutions. Founded in 1721, the company is known for its underwriting expertise, integrity, and financial strength, holding a "A+" rating by AM Best.

Responsibilities

• Examines claims data and conducts investigations into routine and moderately complex claims to determine coverage, compensability, subrogation and benefits under moderate supervisory direction.
• Adjusts and manages claims within the limit of assigned authority.
• Verifies and determines applicability of coverage.
• Initiates 24-hour contact with employer, employee and 48-hour contact with attending physician.
• Handles catastrophic claims with supervisory oversight.
• Conducts telephone investigations as required by company claims handling manual and procedures.
• Evaluates and adjusts claims within the limits of authority.
• Consults with Claim Manager on those claims where assistance and consultation is needed.
• Makes assignments to nurse case management when indicated, monitoring their billing and performance.
• Sets reserves for anticipated exposure up to authority limits.
• Completes mandatory Reserve Worksheets.
• Establishes reserves requiring complex analysis with lifetime pharmacy and cost inflation.
• Coordinates return to work (RTW) and sets target dates.
• Maintain diaries on maximum three (3) month intervals.
• Documents files in the claims system.
• Reviews medical bills for causal relationship, medical bill charges for appropriateness and approves payments.
• Adheres to special account handling (SHI) instructions.
• Attends account meetings by telephone and in-person.
• Manages litigation on the files.

Requirements

• College degree, B.A. or equivalent experience.
• 3+ years experience handling workers compensation claims.
• Strong organizational skills.
• Good time management skills.
• Foreign language communications a plus.
• Excellent verbal and written communication skills are essential.
• Strong aptitude and knowledge of Microsoft Office programs and the ability to quickly learn new programs.

Qualifications

• Must be well versed in California Compensation statute claims.
• Receives lost time and complex medical only assignments.
• Will abide by departmental policies and procedures, including authority levels, to comply with C&F’s risk management controls.

Skills

• Knowledge of California Compensation statute claims.
• Ability to handle complex medical claims.
• Strong organizational and time management skills.
• Microsoft Office proficiency.

Benefits

• Generous 401K employer match.
• Employee Stock Purchase plan with employer matching.
• Generous Paid Time Off.
• Comprehensive benefits that go beyond health, dental & vision.
• Programs focused on family wellness, including physical, mental, and financial wellbeing.
• Tuition reimbursement, industry-related certifications, and professional training.
• A dynamic, ambitious, fun, and exciting work environment.
• Matching donation program and volunteer opportunities.
• An employee-driven corporate giving program.

Pay

The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $55,800.00 to a maximum of $104,900.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee’s contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs.

Schedule

Full-time position.