Role OverviewAs a Claims Specialist, Workers Compensation, you will serve as a strategic advisor and liaison between clients, insurance carriers, and third-party administrators (TPAs). This role ensures that claims are managed effectively, supports clients in navigating complex claim processes, and promotes best practices in workers' compensation programs.
What You Will Do
You will act as the primary point of contact for clients regarding workers' compensation claims, advocate for aggressive investigation of questionable claims, and use sub-rosa surveillance when appropriate. You will also monitor open claims to ensure timely and appropriate handling by Carriers/TPAs, provide guidance on claim strategy and resolution options, and identify opportunities for claim closure, cost containment, and fraud prevention.
Why It Might Be a Fit
To be successful in this role, you will need to have a strong understanding of CA WCAB processes, reserves, litigation strategy, and the ability to interpret loss runs, mod worksheets, and actuarial data. You will also need to have excellent communication skills, both written and oral, and proficiency with Excel, Word, and RMIS platforms.
Requirements
- 7-10+ years CA workers' compensation claims handling or consulting experience
- SIP certificate required
- Strong understanding of CA WCAB processes, reserves, litigation strategy
- Ability to interpret loss runs, mod worksheets, and actuarial data
- Excellent communication skills - both written and oral
- Proficiency with Excel, Word, and RMIS platforms
Benefits
- Medical, Dental, Vision
- Life Insurance and AD&D
- FSA / HSA
- Accident
- Critical Illness
- Hospital Indemnity
- Supplemental Health Insurance
- EAP
- Pet Insurance
- 11 Paid Holidays
- Flexible PTO
- 401K
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