Emergent Holdings logo
Emergent Holdings

We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

Workers' Comp Claim Representative III - CA

Claims SpecialistClaims SpecialistFull TimeRemoteMid LevelTeam 1,001-5,000

Location

United States

Posted

39 days ago

Salary

$64.9K - $108K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Workers' Comp Claim Representative III - CA

Emergent Holdings

SUMMARY This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large, more complex customers requiring high touch, labor intensive claim service. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Mentors lower-level claim handlers. Coordinates special projects and provides guidance to others. Candidate must have California experience. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. - Verifies workers’ compensation coverage of employers and injured employees. - Determines compensability under workers’ compensation by thorough investigation of the claim. - Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. - Facilitates return to work for the injured employee. - Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. - Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies. - Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury. - Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses. - Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition. - Works closely with manager on complex files or files above settlement/reserve authority. - Manages outside vendors to ensure cost containment efforts. - Establishes and maintains effective working relationships with all internal and external customers. - Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws. - Mentors team members. - Conducts audits of claim files. - Acts as a backup for team leader. - Coordinates special projects. EDUCATION AND EXPERIENCE - Relevant combination of education and experience may be considered in lieu of degree. - Bachelor’s degree in a related field. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged. - Five (5) years of experience in a workers’ compensation claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing complex workers’ compensation claims. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred. - OR - Two (2) years of AF Group Claims Representative II experience that includes discretion in determining compensability of complex claims and/or handling complex, high touch or labor-intensive customers. QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. OTHER SKILLS AND ABILITIES - Ability and proficiency in the use of computers and company standard software specific to position. - Knowledge of medical and legal terminology related to work. - Knowledge of workers’ compensation laws and regulations, including jurisdictional laws. - Effective oral and written communication skills. - Effective customer service skills. - Ability to negotiate, build consensus and resolve conflict. - Ability to manage multiple priorities and meet established deadlines. - Attention to detail and analytical skills. - Ability to work independently as well as within a team. - Ability to make independent decisions. - Ability to solve complex problems. - Ability to train and mentor others. ADDITIONAL INFORMATION The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment. PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $64,900 and $108,7000. We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract. #LI-CD1 #AFG

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Emergent Holdings logo

Workers' Comp Claim Representative II - CA

Emergent Holdings

We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

Full TimeRemoteTeam 1,001-5,000

SUMMARY: Claim Representative I: This is the entry level professional claim handler. Handles medical only and indemnity benefits. Exercises some discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Claim Representative II: This is the intermediate level of the claim handler career path. Handles moderate to difficult claims. Exercises progressively more discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Claim Representative III: This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large, more complex customers requiring high touch, labor intensive claim service. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Mentors lower level claim handlers. Coordinates special projects and provides guidance to others. RESPONSIBILITIES/TASKS: Claim Representative I, II, III: - Verifies workers’ compensation coverage of employers and injured employees. - Determines compensability under workers’ compensation by thorough investigation of the claim. - Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. - Facilitates return to work for the injured employee. - Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. - Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies. - Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury. - Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses. - Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition. - Works closely with manager on complex files or files above settlement/reserve authority. - Manages outside vendors to ensure cost containment efforts. - Establishes and maintains effective working relationships with all internal and external customers. - Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws. ADDITIONAL RESPONSIBILITIES/TASKS: Claim Representative II, III: - Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts. - Exercises independent judgment to settle cases prior to mediation or litigation. - Actively participates in agent/client relationship management. - Assists in mentoring team members. Claim Representative III: - Mentors team members. - Conducts audits of claim files. - Acts as a back up for team leader. - Coordinates special projects. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS EDUCATION OR EQUIVALENT EXPERIENCE: Claim Representative I, II, III: Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged. EXPERIENCE: Claim Representative I: Minimum one year relevant experience that provides the necessary skills, knowledge and abilities or completion of claims trainee program. Bilingual skills preferred. Claim Representative II: Three years experience in a workers’ compensation claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing workers’ compensation claims. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred. OR One year of AF Group Claims Representative I experience that includes handling of difficult or complex claims. Claim Representative III: Five years experience in a workers’ compensation claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing complex workers’ compensation claims. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred. OR Two years of AF Group Claims Representative II experience that includes discretion in determining compensability of complex claims and/or handling complex, high touch or labor intensive customers. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Claim Representative I, II, III: - Ability and proficiency in the use of computers and company standard software specific to position. - Knowledge of medical and legal terminology related to the work. - Knowledge of workers’ compensation laws and regulations, including jurisdictional laws. - Effective oral and written communication skills. - Effective customer service skills. - Ability to negotiate, build consensus and resolve conflict. - Ability to manage multiple priorities and meet established deadlines. - Attention to detail and analytical skills. - Ability to work independently as well as within a team. ADDITIONAL SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Claim Representative II, III: - Ability to make independent decisions. - Ability to solve complex problems. Claim Representative III: - Ability to train and mentor others. WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. Minimal travel required. PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $56,700 and $94,900. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract. #LI-CD1 #AFG

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Full TimeRemoteTeam 10,001+H1B Sponsor

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. • Negotiating settlement of claims within designated authority. • Communicating claim activity and processing with the claimant and the client. • Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

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Job Closed
ISC (Integrated Specialty Coverages, LLC) logo

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ISC (Integrated Specialty Coverages, LLC)

Comprehensive Insurance Solutions for an Evolving Market

Full TimeRemoteTeam 201-500H1B No Sponsor

• Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, positive behavior and effort to achieve goals and objectives • Building and maintaining productive relationships with internal and external customers, including clients, underwriting and service teams, and agents • Research applicable coverage for our insureds. Document coverage dates, limits, and restrictions • Identify and resolve any potential coverage questions. Draft reservation of rights and coverage denials for review and approval by their Supervisor/Manager • Investigate facts of the loss by securing statements and supporting documentation such as contracts, cost of repair estimates, expert reports, photos, correspondence, etc • Document activities in writing within claim files • Exercise judgment in applying legal liability to assigned claims and will have settlement authority up to their specific authority, which may vary from carrier to carrier • Assign defense counsel to answer and defend lawsuits where appropriate. Monitor and direct defense counsel, independent adjusters, and experts • Identify claims with potential exposure in excess of authority and advise their Supervisor/Manager • Evaluate, set, or recommend reserves for each file they are handling • Prepare written reports as dictated by company policy and procedures • Handle claims within guidelines of the Fair Claims Practices 790.03 • Provide insureds, claimants, underwriters, and carriers with regular updates on status of file handling • Discuss unique and complex files with Supervisor/Manager

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Gallagher logo

Senior Claims Adjuster

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Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on protected characteristics by applicable federal, state, or local laws.

Full TimeRemoteTeam 5,001-10,000

Introduction At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose. How you'll make an impact - Apply claims management experience to execute decision-making to analyze claims exposure, plan the proper course of action, and appropriately resolve claims. - Interact extensively with various parties involved in the claim process to ensure effective communication and resolution. - Provide exceptional customer service to our claimants on behalf of our clients exhibiting empathy through each step of the claims process - Handle claims consistent with clients' and corporate policies, procedures, and standard methodologies in accordance with statutory, regulatory, and ethics requirements. - Document and communicate claim activity timely and efficiently, supporting the outcome of the claim file. About You Ideal candidates for this position will have: • Claims Background: Commercial General Liability • Jurisdictional Experience: Any • Active Adjusters' licenses: Any As a key member of our experienced Claims Adjuster team, you will: - Investigate, evaluate, and resolve complex General Liability claims with moderate supervision, engaging your analytical skills to make decisions and bring claims to resolution. - Work in partnership with our clients to deliver innovative solutions and enhance the claims management process - Think critically, solve problems, plan, and prioritize tasks to optimally serve clients and claimants Required Qualifications: • High School Diploma. • Minimum of 5 years related claims experience. • Appropriately licensed and/or certified in all states in which claims are being handled. • Knowledge of accepted industry standards and practices. • Computer experience with related claims and business software. Desired Qualifications: • Bachelor's Degree • Retail Claims • Property Damage Claims • Bodily Injury Claims • Litigation Management • Contractual Indemnification, Risk Transfer, Tenders #LI- WG1 #LI- Remote

United States