This position can be filled in ANY CA Branch

Flexible Hybrid Work from Home

Investigate, analyze, and determine the extent of company's liability concerning catastrophic claim exposures and attempt to resolve the case via sustainable return to work or settlement. Correspond with and personally meet with medical specialists, agents, witnesses, or Injured Worker's to compile information as needed and mitigate litigation. Calculate benefit payments and approve payment of Claims. All tasks are to be performed with the goal of demonstrating Zenith's superior Claims handling expertise and commitment to quality medical care.

• Under broad management direction, works at the highest authority limits on assignments reflecting the highest degree of technical complexity and coordination.
• Responsible for Claims management of assigned case load within guidelines of published performance standards.
• Opens new Claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and/or Zenith timeframes and guidelines.
• Creates and executes action plans needed to bring case to closure.
• Manages reassigned cases by identifying salient issues that are keeping the case from resolving and creating appropriate plans to resolve those issues.
• Identifies and coordinates the use of appropriate resources to help manage the claim.
• On-site visits with Injured Worker’s, family members and specialized medical providers to build rapport, better understand issues impacting the claim, and set rehabilitation expectations.
• Sets appropriate reserves according to Zenith’s timeframes and guidelines.
• Follows appropriate procedures for system documentation to preserve data integrity.
• Monitors and maintains accuracy of reserves over the life of the claim; when new information is received re-evaluates and recommends reserves according to Zenith’s standards.
• Completes detailed settlement evaluations and recommends appropriate settlement value, within authority; negotiates claim settlements with injured workers and/or injured workers’ attorneys.
• Has working knowledge of MSA requirements and their impact on catastrophic Claims.
• Maintains regular contact with injured workers, medical providers, employers and agents to develop positive relationships, mitigate litigation and establish credibility.
• Apply principles of critical thinking to define problems, collect data, establish facts, and draw valid conclusions.
• Works productively and harmoniously with other experts on a consistent basis.
• Ability to effectively communicate and interact with Executive Claim Management on a regular basis, as well as other field and corporate business partners.
• Respond positively to direction and feedback on performance.
• Consistently maintain professional and appropriate demeanor.
• Train and mentor less skilled Claims specialists, as needed.
• Perform other duties as assigned.

Education, Skills and Qualifications

• High School Diploma Or equivalent required
• Bachelor’s Degree or equivalent combination of training/experience required.
• Experience Qualifications
• 6+ Years workers’ compensation Claims handling experience required.
• Advanced technical workers’ compensation Claims knowledge.
• Strong verbal and written communication skills with emphasis on telephone and in person communication required.
• Strong math and reading skills required.
• Meets all state regulatory standards regarding licensing, continuing education, and other requirements.

The expected salary range for this position is $115,274.51 to $128,082.79. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at Zenith Insurance Company.