Workers Compensation Claims Specialist II

136909

Zurich is seeking an experienced Workers' Compensation Claims Specialist II to join our dedicated litigated claims team. This remote opportunity is available to candidates based in California who possess a valid Self-Insured (SIL) License and a proven track record of managing complex, litigated Workers' Compensation claims.

The Workers Compensation Claims Specialist will handle multi-party commercial line Workman's Compensation claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.

In this role you will be responsible for:

• Document claims file by accurately capturing and updating claims data/information in compliance with best practices for worker's compensation claims of moderate to high exposure and complexity.
• Exercise judgment to determine compensability 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

Basic Qualifications:

• Bachelor degree and 3 or more years of experience in the Claims or Insurance area OR
• Zurich Certified Insurance Apprentice, including an associate degree with 3 or more years of experience in the Claims or Insurance area. OR
• Completion of Zurich Claims Training Program and 2 or more years of experience in the Claims or Insurance area. OR
• High School Diploma Equivalent and 5 or more years of experience in the Claims or Insurance area. AND
• Must obtain and maintain required adjuster license(s)
• Knowledge of insurance regulations, markets and products

Preferred Qualifications:

• Valid California Self-Insured (SIL) License.
• 5+ years of experience handling high-exposure Workers' Compensation claims involving complex medical, legal, and indemnity issues.
• California jurisdictional experience.
• Experience in handling commercial claims for a major insurance carrier.
• Proven experience managing litigated claims, including directing defense counsel, developing litigation strategy, participating in mediations and settlement conferences, and maintaining appropriate indemnity, medical, and expense reserves.
• Experience handling claims transfers and transitions, with the ability to quickly evaluate exposure, establish action plans, and drive claims toward resolution.
• Knowledge of Owner-Controlled Insurance Programs (OCIPs), Wrap-Up programs, and construction-related claim handling.
• Strong understanding of coverage analysis, compensability determinations, reserve management, and risk transfer opportunities, including contractual liability and third-party recovery.
• Exceptional verbal and written communication skills, with the ability to explain complex claim and coverage issues to clients, customers, brokers, and other stakeholders.
• Strong analytical, critical thinking, and problem-solving skills, with the ability to evaluate exposure, interpret policy language, and identify trends.
• Demonstrated ability to manage…