Crum & Forster · 2 days ago
Senior Claims Specialist - Workers Compensation - CA
United States
Full-time
Remote
Mid, Senior Level
$56K/yr - $105K/yr
3+ years expCrum & Forster is a longstanding insurance company providing specialty and standard commercial lines insurance products. They are seeking a Senior Claims Specialist who will examine claims data, conduct investigations, and manage claims under moderate supervision, specifically in the California Workers Compensation jurisdiction.
Commercial InsuranceHealth CareInsuranceRisk Management
Hiring Manager
Andy Vu
Responsibilities
Examines claims data and conducts investigations into routine and moderately complex claims to determine coverage, compensability, subrogation and benefits under moderate supervisory direction
Adjusts and manages claims within the limit of assigned authority
Receives lost time and complex medical only assignments
Verifies and determines applicability of coverage
Initiates 24-hour contact with employer, employee and 48-hour contact with attending physician
Handles catastrophic claims with supervisory oversight
Conducts telephone investigations as required by company claims handling manual and procedures
Evaluates and adjusts claims within the limits of authority
Consults with Claim Manager on those claims where assistance and consultation is needed
Makes assignments to nurse case management when indicated, monitoring their billing and performance
Sets reserves for anticipated exposure up to authority limits
Completes mandatory Reserve Worksheets
Establishes reserves requiring complex analysis with lifetime pharmacy and cost inflation
Coordinates return to work (RTW) and sets target dates
Maintain diaries on maximum three (3) month intervals
Documents files in the claims system
Reviews medical bills for causal relationship, medical bill charges for appropriateness and approves payments
Adheres to special account handling (SHI) instructions
Attends account meetings by telephone and in-person
Manages litigation on the files
Qualification
Required
Experience with California Workers Compensation jurisdiction is required for this role
Must be well versed in California Compensation statute claims
College degree, B.A. or equivalent experience
3+ years of experience handling workers compensation claims required
Strong organizational skills
Good time management skills
Excellent verbal and written communication skills are essential
Strong aptitude and knowledge of Microsoft Office programs and the ability to quickly learn new programs
Will abide by departmental policies and procedures, including authority levels, to comply with C&F's risk management controls
Preferred
5+ years preferred
Foreign language communications a plus
Benefits
Competitive compensation package
Generous 401K employer match
Employee Stock Purchase plan with employer matching
Generous Paid Time Off
Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeing
A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path
A dynamic, ambitious, fun and exciting work environment
We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community
Company
Crum & Forster
Crum & Forster specializes in commercial insurance, claims, risk assessments as well as accident and health insurance.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
David Thomas
Senior Vice President - Head of Surety Claims
David Webb
Senior Vice President, C&F Stop Loss
Recent News
2025-11-11
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