Workers Compensation Associate Claim Rep - Walnut Creek, CA

Military Spouse Corporate Career Network•Walnut Creek, CA

2d•Onsite

About The Position

As an Associate Claim Rep, Workers Compensation, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. This position focuses on developing your skills and knowledge to successfully manage workers compensation claims. This program can typically last up to 12 months and upon successful completion of this program you will have the skills needed to handle claims independently and progress toward full claims handling responsibility.

Requirements

High School Diploma or GED
one year of customer service experience
Proficient in Microsoft Office (Word, Excel, Outlook)
willingness to learn claims management
Strong verbal and written communication skills with the ability to convey information clearly and professionally.
Ability to exercise sound judgement and make effective decisions within established authority.
Exceptional customer service skills and commitment to providing a positive experience for insureds and claimants.
Attention to detail and organizational skills; ability to manage multiple tasks and prioritize effectively.
Basic conflict resolution skills; willingness to learn techniques for facilitating productive discussions and negotiations.
Demonstrated openness to continuous learning.

Nice To Haves

Bachelor’s Degree.
Previous internship or work experience in customer service or insurance.
Willingness to obtain an active adjuster license where required by state law.

Responsibilities

Actively participate in structured training classes covering insurance policies, specific claim processes, systems, and procedures, including virtual, classroom, and on-the-job training.
Assist in reviewing, investigating, and documenting Workers Compensation claims under close supervision.
Investigate, develop, and evaluate action plans for claim resolution.
Assess coverage and determine if a claim is compensable under Workers Compensation including evaluating claims for potential fraud.
Participate in Telephonic and/or onsite File Reviews.
Learn how to determine coverage, compensability, and exposure based on policy terms and claim facts.
Gather information from policyholders, claimants, witnesses, and third-party providers.
Communicate and apprise all parties regarding claim status which may include our business customers, injured employees, medical providers, and legal counsel.
Maintain accurate records of claim activity in claim management systems.
Achieve a positive result by returning an injured party to work when appropriate. This may include coordinating medical treatment in collaboration with internal or external resources.
Demonstrate openness to continuous learning, particularly in AI and digital transformation.
Acquire and maintain relevant Insurance License(s) to comply with state and Travelers’ requirements within three months of starting the job.
Perform other duties as assigned.