Workers' Compensation Claims Specialist OR Senior Specialist – Public Risk Innovation, Solutions, and ...

Public Risk Innovation, Solutions, and Management (PRISM) is a joint powers authority (JPA) that provides risk management and coverage programs for over 2,000 public entities throughout California. Our organization is member-driven, offering numerous opportunities for members to participate in the governance of our JPA.

About the role

This position may be filled at the Specialist or Senior Specialist level, depending on the selected candidate's qualifications. The Workers' Compensation Claims Specialist/Senior Workers' Compensation Specialist manages a caseload of excess workers' compensation claims, including complex and catastrophic claims (future medical and possibly indemnity claims at the Specialist level). The role also involves providing oversight of Third-Party Administrators (TPAs) and claims processes in both our Primary Workers' Compensation (PWC) and Excess Workers' Compensation (EWC) Programs.

Responsibilities

• Review and oversee claims for appropriate medical care, reserves, reimbursement, reinsurance, and resolution.
• Manage a caseload of excess workers' compensation claims, including complex and catastrophic claims.
• Provide oversight of TPAs and claims processes in both Primary Workers' Compensation (PWC) and Excess Workers' Compensation (EWC) Programs.