Workers Compensation Claims Specialist

TEKsystems•Brea, CA

2d•$60 - $80•Hybrid

About The Position

This is a Contract to Hire position based out of Brea, CA. The role involves performing a combination of duties related to workers' compensation claims, including interpreting policy coverages, setting activities, authorizing payments, coordinating investigations, evaluating claims and suits, and developing settlement packages. The specialist will partner with various stakeholders to ensure timely and cost-effective resolution of complex claims, analyze claim activities, prepare reports, and maintain up-to-date knowledge of state regulations and industry trends. Data input for claim circumstances and other business-relevant information is also a key responsibility. The role may also involve providing guidance to other claims staff.

Requirements

Bachelor's degree or equivalent experience.
Typically a minimum three to five years claims experience.
CA Certifcation required
Solid knowledge of claims and insurance industry theory and practices.
Demonstrated technical expertise and product specific knowledge.
Strong interpersonal, communication and negotiation skills. Ability to effectively interact with all levels of internal and external business partners.
Ability to work independently, managing time and resources to accomplish multiple tasks and meet deadlines.
Strong analytical and problem solving skills enabling viable alternative solutions.
Ability to exercise independent judgement and make critical business decisions effectively assessing the merits of claims as well as evaluating claims based on a cost benefit analysis.
Solid knowledge of Microsoft Office Suite as well as other business-related software.
Ability to adapt to change and value diverse opinions and ideas.
Ability to fully comprehend claim information; and to further articulate analyses of claims in internal reports.
Ability to handle claims with a proactive long-term view of business goals and objectives.

Nice To Haves

Professional designations preferred.

Responsibilities

Interprets more complex or unusual policy coverages and determines if coverages apply to claims submitted, escalating issues as needed.
Sets activities, reserves and authorizes payments within scope of authority. Ensures issuance of disbursements while managing loss costs and expenses.
Coordinates and performs investigations and evaluates claims and suits through contact with insureds, claimants, business partners, witnesses and experts. Seeks early resolution opportunities.
Identifies claims with third party recovery potential and coordinates with subrogation/salvage unit.
Partners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims.
Analyzes claims activities. Prepares and presents reports for management. May be responsible for special projects and presentations.
Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes.
May provide guidance and assistance to other claims staff and functional areas.
Keeps current on state/territory regulations and issues as well as industry activity and trends.
May perform additional duties as assigned.