Worker's compensation claims examiner job description

Zurich is growing our Workers Compensation Claims team in California! We have multiple opportunities available to work out of our Rancho Cordova or Woodland Hills office in California. While this position will be based out of either our Rancho Cordova or Woodland Hills, CA offices, we are offering the flexibility to work both in the office and remotely. You will collaborate with your manager to set a schedule that supports you, our customers and the team.

If you are ready for a career move, consider working for a company with a global footprint that offers an excellent work/life balance, terrific benefits including an incentive plan, 401K match and a second 401K company contribution, flexible work options, summer hours and a great culture.

To handle Workers' Compensation claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.
Job Accountabilities:
Document claims file by accurately capturing and updating claims data/information in compliance with best practices for single and multi-party personal or commercial line claims of moderate to high exposure and complexity. Exercise judgment to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence. Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage. Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate. Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims. Assess damages by calculating applicable damages or range of damages allowed by law. Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits. Meet quality standards by following best practices
Basic Qualifications:
Bachelor's Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.
OR Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area.
OR Zurich Certified Insurance Apprentice, including an Associate Degree with 6 or more years of experience in the Claims and/ or Litigation Management area.
OR Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area.
OR High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area.
AND Must obtain and maintain required adjuster license(s) Microsoft Office experience Knowledge of insurance regulations, markets and products
Preferred Qualifications:
Effective verbal and written communication skills Strong analytical, critical thinking and problem-solving skills Strong multi-tasking and prioritization skills Experience collaborating in a team environment and building cross functional working relationships Proactively shares and promotes sharing of insights Ability to gather unique perspectives from other teams/functions to optimize outcomes. Understands, analyzes, and applies the component parts of an insurance policy for complex claims Ability to follow reserving process for indemnity and expense in analyzing the potential exposure of complex claims Ability to determine the scope and exposure for complex claims Ability to leverage trend and relationships to provide high-quality customer service Well-versed in identifying, understanding and explaining complex financial and/or actuarial trends/concepts. Ability to effectively communicate coverage determinations to customers/clients/brokers for complex claims Ability to direct counsel on an ongoing basis to guide the course of complex litigation and settlement strategies

As a condition of employment at Zurich, employees must adhere to our COVID-related health and safety protocols ( ), including, without limitation, a requirement that employees attest as to their vaccination status with a YES/NO, and upload proof of vaccination status, or a negative COVID test result when applicable, to a third-party vendor. These protocols are continuously re-evaluated and the requirements may change at any time.

A future with Zurich. What can go right when you apply at Zurich?

Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500 . Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click here to learn more.

As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers' expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet

Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission.

Location(s): AM - Woodland Hills, AM - Rancho Cordova
Remote Working: Hybrid
Schedule: Full Time

Linkedin Recruiter Tag:

Chubb is currently seeking a Workers' Compensation Lost Time Claim Specialist for our Northeast, New York, and New Jersey Region. The successful applicant will be handling claims from Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, and New Jersey. The position will report to a Claim Manager and reside in either our New Haven, Connecticut.SG22
Duties & Responsibilities:

- Independently handles all aspects of workers' compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.

- Reviews claim and policy information to provide background for investigation.

- Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers.

- Evaluates the facts gathered through the investigation to determine compensability of the claim.

- Informs insureds, claimants, and attorneys of claim denials when applicable.

- Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc.

- Timely administration of statutory medical and indemnity benefits throughout the life of the claim.

- Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to Team Leader throughout the life of the claim.

- Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.

- Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.

- Works with attorneys to manage hearings and litigation

- Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.

- Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.

- Files workers' compensation forms and electronic data with states to ensure compliance with statutory regulations.

- Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.

- Works with in-house Technical Assistants, Special Investigators, Nurse

Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.

Qualifications:

Education & Requirements:

- 3 - 5 years of prior Workers' Compensation Lost Time claim handling experience

- Experience working in a customer focused, fast-paced, fluid environment

- Experience utilizing strong communication and telephonic skill

- Prior experience demonstrating a high level of organization, follow-up, and accountability

- AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required

- Experience with litigation management

- Experience with subrogation investigation

- Experience with fraud investigation

- Experience with medical case management

- Knowledge of medical terminology

- Conduct reserve analyses to ensure adequacy and demonstrate financial acumen

- If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.

- Proficiency with Microsoft Office Product

Chubb offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, a generous retirement savings plan, disability coverage, stock purchase plan, flexible spending accounts, tuition reimbursement, and business casual dress. At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religion, age, sex, sexual orientation, transgender, national origin, disability, genetic information, veteran or marital status, or any other characteristicprotected by law.

The Workers' Compensation (WC) Claims Examiner II understands and participates in every aspect of the WC claim process. Working in a team approach, the WC Examiner II will make decisions concerning reserve adjustments, develop a plan of action, and determine the appropriate settlement value. The WC Claims Examiner II also works with the In-take Coordinators, the broker of record, the WC Manager and fellow Maxim co-workers at every level of the business.
Essential Duties and Responsibilities:

+ Manages and resolves new, pending, and litigated workers compensation files

+ Participates in and leads conference calls with local offices, third-party administrators (TPAs), medical providers, attorneys, and other Maxim team members

+ Monitors TPA's file resolution plans

+ Ensure legal deadlines are met

+ Represents Maxim in depositions, mediation, and conference calls regarding assigned claim files

+ Provides, reviews and comments on the financial aspects of assigned claims files

+ Educate branch offices about all aspects of Workers' Compensation

+ Provides excellent customer service to injured employees

+ Guides and advises Intake Coordinators and handles work overflow when necessary

+ Prepares WC claim reports for review by department management team

+ Reviews, identifies and make recommendations for maintaining control and/or reducing the claims experience (loss history) of the company

+ Assists Manager in achieving overall department goals

+ Performs other duties as assigned/necessary

Minimum Requirements:

+ College degree preferred; or equivalent work experience

+ Five to Seven years of Workers' Compensation experience preferred

+ Some legal experience strongly preferred

+ Good organizational skills and attention to detail

+ Ability to work independently and cooperatively in a team environment

+ Ability to communicate effectively and provide excellent customer service with individuals at all levels of the organization

+ Computer proficiency, including Microsoft Office applications, required

+ Prior experience performing internet research

+ Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills; proficiency in the English language may be required

+ Flexible work hours such that over time can be worked if needed

#Homecare

Benefits

At Maxim Healthcare Services, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:

+ Competitive pay & weekly paychecks

+ Health, dental, vision, and life insurance

+ 401(k) savings plan

+ Awards and recognition programs

*Benefit eligibility is dependent on employment status. **CO Specific Benefits: Medical/Prescription, Dental, Vision, Health Advocacy (company paid if enrolled Medical), Health Advocate Employee Assistance Program, Health Savings Account , 401(k), 401(k) Company Match, Profit Sharing, Short Term Disability, Long Term Disability, Primary Caregiver Leave, Parental Leave, Life and Basic Accidental Death & Dismemberment Insurance, Voluntary Life and Accidental Death & Dismemberment Insurance, Hospital Expense Protection Plan, Critical Illness Insurance, Accident Insurance, Dependent Care Flexible Spending Account, Home and Auto Insurance, Pet Insurance, Transportation Benefits, CommonBond, Educational Assistance Program, College Partnership Program, Paid Time Off/Company Holidays

About Maxim Healthcare Services

Maxim Healthcare Services has been making a difference in the lives of our patients, caregivers, employees and communities for more than 30 years. We offer private duty nursing, skilled nursing, physical rehabilitation, companion care, respite care and behavioral care for individuals with chronic and acute illnesses and disabilities. Our commitment to quality customer service, compassionate patient care, and filling critical healthcare needs makes us a trusted partner wherever care is needed.

Maxim Healthcare Services is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.