Senior Claims Specialist, Workers Comp.

Crum & Forster

. Examine claims data and conduct investigations into routine and moderately complex workers compensation claims .

Posted 9/16/2026full-timeRemote • California • United StatesSenior💰 $55,800 - $104,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing and adjusting workers compensation claims, including conducting investigations, determining coverage, and coordinating return-to-work processes. Proficient in adhering to California Compensation statutes and maintaining compliance with departmental policies and procedures.

Highest-signal resume keywords

Workers Compensation Claims ManagementCalifornia Compensation Statute KnowledgeClaims Investigation and AnalysisMicrosoft Office ProficiencyStrong Organizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Data ExaminationCoverage DeterminationClaims AdjustmentReserve SettingMedical Bill ReviewTelephone InvestigationsSubrogation AnalysisReturn to Work CoordinationClaims System DocumentationLitigation Management

Soft Skills

Excellent Verbal CommunicationExcellent Written CommunicationGood Time Management

Industry Keywords

Workers CompensationClaims Handling ProceduresRisk Management ControlsNurse Case ManagementCausal Relationship Analysis

About the role

Key responsibilities & impact

Examine claims data and conduct investigations into routine and moderately complex workers compensation claims
Determine coverage, compensability, subrogation and benefits
Adjust and manage claims within assigned authority limits
Receive lost time and complex medical-only assignments
Verify and determine applicability of coverage
Initiate 24-hour contact with employer and employee, and 48-hour contact with attending physician
Handle catastrophic claims with supervisory oversight
Conduct telephone investigations according to company claims handling procedures
Consult with the Claim Manager when assistance is needed
Assign claims to nurse case management and monitor billing and performance
Set reserves for anticipated exposure within authority limits
Complete mandatory Reserve Worksheets and establish reserves requiring complex analysis
Coordinate return to work and set target dates
Maintain diaries at intervals of no more than three months
Document files in the claims system
Review medical bills for causal relationship and appropriateness of charges, and approve payments
Adhere to special account handling instructions
Attend account meetings by telephone and in person
Manage litigation on assigned files

Requirements

What you’ll need

College degree, B.A. or equivalent experience
3+ years of experience handling workers compensation claims
Well versed in California Compensation statute claims
Strong organizational skills
Good time management skills
Excellent verbal and written communication skills
Strong aptitude and knowledge of Microsoft Office programs
Ability to quickly learn new programs
Foreign language communications a plus
Must abide by departmental policies and procedures, including authority levels, to comply with C&F’s risk management controls

Benefits

Comp & perks

Competitive compensation package
Generous 401K employer match
Employee Stock Purchase plan with employer matching
Generous Paid Time Off
Health, dental and vision benefits
Wellness programs focused on physical, mental and financial wellbeing
Tuition reimbursement
Industry-related certifications
Professional training
Dynamic, ambitious, fun and exciting work environment
Matching donation program
Volunteer opportunities
Employee-driven corporate giving program