Sr. Claims Specialist, Workers Compensation

Sr. Claims Specialist, Workers Compensation

5 days ago - Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

Zurich is seeking an experienced Workman’s Compensation Sr. Claims Specialist to join our team! We are specifically seeking candidates who can work remotely from California. However, we are open to considering applicants from other locations if they are currently licensed in the state of California.

At Zurich North America Claims, we acknowledge that work-life balance and flexibility are a priority when it comes to choosing your next career move. The ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location while facilitating in-person connections and collaborative activities when meaningful and valuable.

The Senior Workers Compensation Claims Specialist will handle single and multi-party commercial line Workman’s Compensation claims of moderate to high exposure and complexity within specific authority limits, ensuring that claims are handled efficiently, effectively, and with customer-centric service.

• 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.

• 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

• 6 or more years of experience handling high severity Workers Compensation litigated claims
• Currently holds an active adjusters license in the state of California
• 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…