• To analyze complex errors and omissions, directors and officers claims • To provide resolution of highly complex nature and/or severe injury claims • To coordinate case management within Company standards, industry best practices and specific client service requirements • To manage the total claim costs while providing high levels of customer service • Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. • Negotiates claim settlement up to designated authority level. • Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. • Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. • Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. • Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. • Represents Company in depositions, mediations, and trial monitoring as needed. • Communicates claim activity and processing with 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. • Delegates work and mentors assigned staff.

• To analyze complex or technically difficult general liability 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; • To identify subrogation of claims and negotiate settlements. • Analyzes and processes complex or technically difficult general liability 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. • Assesses liability and resolves claims within evaluation. • Negotiates settlement of claims within designated authority.

• Manage all liability, cargo, property damage, and personal injury claims arising from trucking and logistics operations. • Conduct thorough investigations of incidents including evidence gathering, witness interviews, and review of driver logs, vehicle maintenance records, and dispatch documentation. • Maintain detailed claims files with complete documentation throughout the lifecycle of each claim from first notice of loss through final resolution. • Determine liability, assess damages, and make coverage decisions in accordance with policy terms and applicable regulations. • Provide regular reporting to senior management and insurance carriers on claims status, trends, and financial exposure. • Identify and pursue all viable subrogation opportunities to recover costs from responsible third parties. • Evaluate each claim for subrogation potential including equipment failure, third-party negligence, warehouse damage, and shipper liability. • Coordinate with legal counsel, insurance carriers, and third-party administrators on subrogation cases. • Negotiate settlements and manage the subrogation process through litigation when necessary. • Develop and maintain relationships with insurance carriers, third-party administrators, legal counsel, and independent adjusters. • Develop and implement claims handling policies, procedures, and best practices aligned with industry standards. • Ensure compliance with all federal and state regulations including FMCSA requirements, DOT regulations, and relevant insurance laws. • Establish and monitor key performance indicators for claims metrics. • Identify trends in claims data and recommend loss prevention strategies. • Train operations staff, drivers, and management on proper claims reporting procedures and accident response protocols. • Maintain accurate claims reserves and adjust as cases develop. • Monitor claims costs and pursue cost containment strategies. • Manage claims budget and track expenses against forecasts. • Analyze loss trends to support insurance renewal negotiations and risk management decisions.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. 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 .