Senior Claims Specialist, CA Workers Comp, Remote

Crum & Forster • Orange, CA

2d • $58,700 - $110,200 • Remote

About The Position

Crum & Forster’s Commercial Lines division provides specialized insurance solutions to mid-sized and large businesses. The Senior Claims Specialist examines claims data and investigates routine and moderately complex claims to determine coverage, compensability, subrogation, and benefits, working under moderate supervisory direction. The role adjusts and manages claims within assigned authority, with particular emphasis on California workers’ compensation claims.

The position handles lost-time and complex medical-only assignments, catastrophic claims with supervisory oversight, medical bill review, reserves, return-to-work coordination, and litigation. The specialist maintains claim documentation and diaries, follows account-specific instructions and company procedures, and consults with the Claim Manager when needed.

Requirements

• Bachelor’s degree or equivalent experience.
• At least 3 years of experience handling workers’ compensation claims.
• Strong organizational skills.
• Good time management skills.
• Excellent verbal and written communication skills.
• Strong aptitude and knowledge of Microsoft Office programs, with the ability to quickly learn new programs.
• Ability to comply with departmental policies and procedures, including authority levels and C&F risk management controls.

Nice To Haves

• Foreign language communication skills.

Responsibilities

• Handle lost-time and complex medical-only claims and verify and determine coverage applicability.
• Initiate contact within 24 hours with the employer and employee, and within 48 hours with the attending physician.
• Handle catastrophic claims with supervisory oversight.
• Conduct telephone investigations according to the company claims handling manual and procedures.
• Evaluate and adjust claims within assigned authority limits.
• Consult with the Claim Manager when assistance or consultation is needed.
• Assign nurse case management when indicated and monitor billing and performance.
• Set reserves for anticipated exposure within authority limits and complete mandatory Reserve Worksheets.
• Establish reserves requiring complex analysis, including lifetime pharmacy and cost inflation.
• Coordinate return to work and set target dates.
• Maintain claim diaries at intervals of no more than three months.
• Document claim files in the claims system.
• Review medical bills for causal relationship and charge appropriateness, and approve payments.
• Follow special account handling (SHI) instructions.
• Attend account meetings by telephone and in person.
• Manage litigation on claims files.

Benefits

• Competitive compensation package.
• Generous 401(k) employer match.
• Employee Stock Purchase Plan with employer matching.
• Generous paid time off.
• Health, dental, and vision benefits, plus programs supporting physical, mental, and financial wellbeing for employees and their families.
• Tuition reimbursement, industry-related certifications, and professional training.
• Matching donation program, volunteer opportunities, and an employee-driven corporate giving program.
• Opportunity to participate in discretionary equity-based compensation and/or performance-based variable pay programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior