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Role Description

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. Experience with California Workers Compensation jurisdiction is required for this role. High preference for candidates in the West Coast but open to candidates in the MST or CST locations.

What you will do for C&F:

• Must be well versed in California Compensation statute claims.
• 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.
• Maintains 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.

Qualifications

• College degree, B.A. or equivalent experience.
• 3+ years of experience handling workers compensation claims required, 5+ years preferred.
• Strong organizational skills.
• Good time management skills.
• Foreign language communications a plus.
• 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.
• Ability for business travel a must.

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, focused on your whole family’s wellness.
• Opportunities for career development, including tuition reimbursement, industry-related certifications, and professional training.
• A dynamic, ambitious, fun and exciting work environment.
• Encouragement of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program.

Company Description

Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry.

Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2024 Great Place to Work® Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion.

C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: www.cfins.com .