SR CLAIMS SPECIALIST
Zenith Insurance Company - San Diego, CA

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** PLEASE NOTE **

This job can be filled in any of our California Branches

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.
  • Advanced technical workers’ compensation claims knowledge.
  • Strong verbal and written communication skills with emphasis on telephone communication required.
  • Strong math and reading skills required.
  • Meets all state regulatory standards regarding licensing, continuing education, and other requirements.
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.

Physical, Mental & Sensory Requirements

Designated

Special

Designated

Function

Yes/No

Requirements

Yes/No

Function

Degree

Sitting

Yes

Hand Manipulation

Yes

Mathematics

Moderate

Walking

Reaching

Yes

Reading

Moderate

Standing

Grasping

Yes

Verbal

Moderate

Bending

Visual

Yes

Written

Moderate

Kneeling

Auditory

Yes

Reasoning

High

Lifting

Driving

May

The above statements are intended to describe the general nature and level of work performed. They are not intended to be an exhaustive or exclusive list of the required responsibilities, duties and skills. Management retains the discretion to add to or change the duties and requirements of this position at any time, as needs dictate.

Zenith Insurance Company - 18 months ago - save job - block
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About this company
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Zenith Insurance Company (“Zenith”) is a national workers’ compensation carrier with more than 60 years of experience...