- Under technical direction, works within significant limits and authority on assignments of higher technical complexity and coordination.
- Responsible for Claims management of assigned cases 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's timeframes and guidelines.
- 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.
- Creates and executes action plans needed to bring case to closure.
- Completes detailed settlement evaluations and recommends appropriate settlement value, within authority; negotiates claim settlements with injured workers and/or injured workers' attorneys.
- Maintains 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.
- Works productively and harmoniously with others on a consistence basis.
- Respond positively to direction and criticism of performance.
- Consistently maintain professional and appropriate demeanor.
- Perform other duties as assigned.
- High School Diploma Or equivalent required
- Bachelor's Degree or equivalent combination of training/experience preferred.
- 1+ Years claims or insurance experience preferred. Previous workers' compensation experience helpful. required
- Basic technical workers' compensation Claims knowledge.
- Strong verbal and written communication skills with emphasis on telephone communication required.
- Strong math and reading skills required.
- Meets all state regulatory standards regarding licensing, continuing education, and other requirements.
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Claims Specialist - Roseville, United States - Zenith
Description
Zenith is a team of Workers' Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers' Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations. In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional.
Investigate, analyze, and determine the extent of company's liability concerning Claims and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of Claims within a certain monetary limit. All tasks are to be performed with the goal of demonstrating Zenith's superior Claims handling expertise.
The essential responsibilities of this position include, but are not limited to, the following:
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.
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