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ADAPTED_NOW

Workers Compensation Examiner

To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

ACTIVE

https://www.youtube.com/watch?v=MxWyD3n8XDo

https://www.youtube.com/watch?v=LEISiTROYm0

https://www.youtube.com/watch?v=3DG3_4O-HMk

Job location: remote or onsite – we are open to either option. Any specific skill/ certification/ license: Self insured certificate, experience handling public entities Years of experience: at least 4 years Candidate should be local to CA only. PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. Prepares necessary state fillings within statutory limits. Manages the litigation process; ensures timely and cost effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services. Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

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Nesco Resource

Claims Examiner - Workers Compensation

CareerBuilder Priority for Arb

Insurance Examiner

Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements. Details:Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.

https://www.youtube.com/watch?v=D4SGf2icuQ8

Title: Sr Claim Examiner- WC REMOTE 2 months plus extensions Details:<ul><li>Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.</li><li>Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel.</li><li>Analyzes claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.</li><li>Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.</li><li>Develops subrogation and third party recovery potential and follows reclaim procedures.</li><li>Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.</li><li>Ability to work independently while assimilating various technical subjects.</li><li>Strong written and oral communication, negotiation and presentation skills.</li><li>Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects.</li></ul>Education:<ul><li> Bachelor's degree or equivalent experience. </li><li>Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization.</li><li>Workers Compensation (WC) Adjuster License required according to jurisdictional requirements.</li></ul>Preferred: Industry designations such as IIA, AIC, AEI and/or CPCU #TB_EN

For over 20 years, TalentBurst Inc. has been an award-winning provider of cutting-edge Workforce Management Solutions. With a strong commitment to staying ahead in the tech landscape, we pioneer innovative approaches to talent acquisition. Our expertise spans Life Sciences, and Healthcare Staffing, Banking, Financial, IT, and Engineering, as well as Global Employer of Record (EOR), Agent of Record (AOR), State, Local Government and Education (SLED), and IC validation/compliance services. Additionally, our division, TalentProcure, leads the industry with offerings such as High Hazard Payroll, Managed Services, and Vendor on Premise (VOP) solutions.
Due to our prioritization of excellent standards, we are Joint Commission Certified and are a certified Minority Business Enterprise (MBE) in the USA and Canada. Supporting over 130 Fortune 500 companies globally, we excel in navigating the landscape of talent acquisition. In a world of constant change, we embrace developing people-centric solutions that address the unique demands of our clients. Stay connected by visiting our website and following us on social media!

TalentBurst

Sr Claim Examiner- WC

Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements. Description : Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.

33897371 Sr Claim Examiner- WC Location : 675 Placentia Avenue, Suite 350, Brea CA 92821 Hybrid role & California required License and Spanish is a Plus ( Speak, Read ) Duration : 3 Months Description : Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted. - Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel. - Analyzes claims activity and prepares reports for clients/carriers and management. - Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements. - Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits. - Develops subrogation and third party recovery potential and follows reclaim procedures. - Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews. Skills: Ability to work independently while assimilating various technical subjects. - Strong written and oral communication, negotiation and presentation skills. - Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects. Education: Bachelor's degree or equivalent experience. - Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization. Workers Compensation (WC) Adjuster License required according to jurisdictional requirements. Preferred: - Industry designations such as IIA, AIC, AEI and/or CPCU

Underwriter

We’ve been dedicated to assembling a team of dedicated Middle Market leaders and underwriters who understand this space very deeply and who grasp the unique challenges of the various industry segments and the individual customers we serve. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals.

KBSkills

Zurich Middle Markets has delivered double-digit growth over the last four consecutive years, and we strive to exceed that growth in the years ahead! We’ve been dedicated to assembling a team of dedicated Middle Market leaders and underwriters who understand this space very deeply and who grasp the unique challenges of the various industry segments and the individual customers we serve. We are looking to add to our team in San Diego and hire an experienced Market Facing Property & Casualty Underwriter. In this role, you will serve as a customer advocate with a focus on improving the customer experience by understanding their unique risks and offering the best end-to-end solution for their Property & Casualty insurance needs. What you can expect in a Market Facing, Middle Markets Underwriting position at Zurich: <ul><li>You will develop and maintain relationships with broker partners and customers across all industries in support of business objectives. </li><li>You will leverage your Property and Casualty underwriting acumen across risk assessment, exposure evaluation and pricing to generate and maintain a profitable book of new and renewal business.</li><li>You will work collaboratively across business units including but not limited to; claims, finance, risk engineering, actuary, and technical underwriting while gaining extensive knowledge in a growing and innovative industry.  </li><li>You will be empowered to use your technical underwriting, negotiation and interpersonal skills to grow and develop relationships with preferred distribution partners in an assigned territory.</li></ul> This role will be filled at either the Mid-Senior or Senior Level. The hiring manager will determine the appropriate level based upon the selected applicant’s experience and skill set relative to the qualifications listed for this position. Mid-Senior Underwriter Basic Qualifications: <ul><li>High School Diploma or Equivalent and 3 or more years of experience in the Underwriting or Market Facing area. OR</li><li>High School Diploma or Equivalent and 6 or more years of experience in the Claims or Underwriting Support area OR</li><li>Zurich Certified Insurance Apprentice including an Associate Degree and 1 or more years of experience in the Underwriting or Market Facing area OR</li><li>Zurich Certified Insurance Apprentice including an Associate Degree and 4 or more years of experience in the Claims or Underwriting Support area AND</li><li>Knowledge of line/s of business and the legal and regulatory guidelines</li><li>Knowledge of time restraints for quotes on new and renewal business</li><li>Experience with Microsoft Office</li></ul> OR Senior Underwriter Basic Qualifications: <ul><li>High School Diploma or Equivalent and 5 or more years of experience in the Underwriting or Market Facing area. OR</li><li>High School Diploma or Equivalent and 10 or more years of experience in the Claims or Underwriting Support area OR</li><li>Zurich Certified Insurance Apprentice including an Associate Degree and 3 or more years of experience in the Underwriting or Market Facing area OR</li><li>Zurich Certified Insurance Apprentice including an Associate Degree and 8 or more years of experience in the Claims or Underwriting Support are AND</li><li>Knowledge of Microsoft Office</li><li>Experience working on time restraints for quotes on new and renewal business</li><li>Experience working in a team environment</li></ul> Preferred Qualifications:  <ul><li>Bachelors Degree</li><li>Strong verbal and written communication skills</li><li>Microsoft Office experience</li></ul> Compensation for roles at Zurich varies depending on a wide array of factors including but not limited to the specific office location, role, skill set, and level of experience. As required by local law, Zurich provides in good faith a reasonable range of compensation for roles. For additional information about our Total Rewards, Click here. Other rewards may include short term incentive bonuses and merit increases. Candidates with salary expectations outside of the range are encouraged to apply, and will be considered based on experience, skill, and education. The salary provided is a nationwide market range and has not been adjusted for the applicable geographic differential associated with the location where the position may be filled. The combined salary range for this position is $90,000.00 - $165,000.00. The starting salary range for the Mid-Senior Market Facing Underwriter is $90,000.00 - $135,000.00 and for the Senior Market Facing Underwriter is $115,000.00 - $165,000.00. <div></div>As an insurance company, Zurich is subject to 18 U.S. Code § 1033. As a condition of employment at Zurich, employees must adhere to any COVID-related health and safety protocols in place at that time (<a href="https://www.zurichna.com/careers/faq" rel="nofollow noopener noreferrer" target="_blank">https://www.zurichna.com/careers/faq</a>). A future with Zurich. What can go right when you apply at Zurich? Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click <a href="https://www.zurichna.com/careers" rel="nofollow">here</a> to learn more. As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet  Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission.  Location(s): AM - California Virtual Office, AM - San Diego Remote Working: Yes Schedule: Full Time Employment Sponsorship Offered: No     Linkedin Recruiter Tag: #LI-WL1 #LI-ASSOCIATE

Zurich Insurance Company Ltd.

Market Facing Underwriter, Middle Markets

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Actuarial Skills

Agriculture

Alliance/Partner Management

Brokerage

Business Support

Communication Skills

Customer Experience

Customer Relations

Distribution Channel

Diversity

Exceeded Sales Goal

Finance

Fortune 500 Customers

High School Diploma

Insurance Certifications

Insurance Underwriting

Interpersonal Skills

Legal

LinkedIn

Microsoft Office

Mortgage Lending

Negotiation Skills

Online Recruiting

Presentation/Verbal Skills

Pricing

Process Improvement

Property and Casualty Insurance

Recruiting/Staffing Agency

Regulations

Resume Search

Risk

Risk Analysis

Risk Management

Safety/Work Safety

Sales Closing Skills

Team Player

Time Management

Underwriting

Writing Skills

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