Workers' Compensation Claims Examiner
1 month ago
This role is a key part of Zenith Insurance Company's hybrid work schedule, offering flexibility to work from home on select days of the week in accordance with the in-office schedule established by regional executive leadership. The selected candidate must be able to report to the regional branch office on a weekly basis.
Job Summary
Investigate and analyze claims to determine the extent of Zenith Insurance Company's liability. Communicate with medical specialists, agents, witnesses, and claimants to gather information. Calculate benefit payments and approve claims within a predetermined monetary limit. The goal is to demonstrate Zenith Insurance Company's superior claims handling expertise.
Key Responsibilities
- Work under technical direction on assignments of higher technical complexity and coordination.
- Manage assigned workers' compensation claims within the guidelines of published performance standards.
- Open new workers' compensation claims, complete three-point contact, and perform necessary investigations to determine compensability and potential subrogation or apportionment, adhering to state and/or Zenith Insurance Company timeframes and guidelines.
- Determine appropriate reserves according to Zenith Insurance Company timeframes and guidelines.
- Follow established procedures for system documentation to maintain data integrity.
- Monitor and maintain the accuracy of reserves throughout the life of the claim. When new information is received, re-evaluate and recommend reserves according to Zenith Insurance Company standards.
- Develop and execute action plans to bring cases to closure.
- Conduct detailed settlement evaluations and recommend an appropriate settlement value, within authority, and negotiate claim settlements with injured workers and/or their attorneys.
- Establish and maintain regular contact with injured workers, employers, and agents to develop positive relationships and establish credibility.
- Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
- Work productively and harmoniously with others on a consistent basis.
- Respond positively to direction and criticism of performance.
- Maintain a professional and appropriate demeanor at all times.
- Perform other duties as assigned.
Education, Skills, and Requirements
- A high school diploma or equivalent is required.
- A bachelor's degree or equivalent combination of training and experience is preferred.
- At least one year of claims or insurance experience is preferred, with previous workers' compensation experience being a requirement.
- Familiarity with technical workers' compensation claims is essential.
- Strong verbal and written communication skills, with an emphasis on telephone communication, are required.
- Strong math and reading skills are essential.
- Compliance with all state regulatory standards regarding licensing, continuing education, and other requirements is mandatory.
The expected salary range for this position is $72,967.82-$91,209.78. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law. Qualifications may warrant placement in a different job level.
Zenith Insurance Company is an equal opportunity employer and considers all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristic. In compliance with California law, we are committed to fair hiring practices. Pursuant to the California Fair Chance Act (AB 1008), we will consider qualified applicants with criminal histories in a manner consistent with the law. Additionally, in accordance with the Los Angeles Fair Chance Initiative for Hiring Ordinance, we will not inquire about an applicant's criminal history until after a conditional offer of employment has been made.
If you are a qualified individual with a disability or a disabled veteran and need assistance accessing our career center or applying for a position due to your disability, you are entitled to request an accommodation. To make a request, please contact a Human resources representative at Zenith Insurance Company.
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