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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in California workers' compensation claims management, including litigation handling, settlement negotiation, and compliance with jurisdictional requirements. Proven ability to analyze complex claims and manage them through timely resolution while maintaining service expectations.
Highest-signal resume keywords
California Workers' Compensation ExperienceLitigated Claims HandlingSettlement NegotiationCalifornia Jurisdictional KnowledgeSIP Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AnalysisBenefit DeterminationClaims InvestigationReserve CalculationClaims Resolution ManagementStatutory Filings PreparationNegotiation SkillsClaims Payment ProcessingSubrogation IdentificationAction Plan Management
Soft Skills
Excellent JudgmentProblem SolvingClear ThinkingStress ManagementTime Management
Tools & Technologies
Claims Management SoftwareComputer Keyboarding
Certifications & Qualifications
SIP CertificationProfessional Certification in Line of Business
Industry Keywords
California Workers' CompensationHigh-Exposure ClaimsLitigation ProcessClient Service RequirementsAdjudication Best Practices
About the role
Key responsibilities & impact- Analyze complex or technically difficult California workers' compensation claims to determine benefits due
- Work with high-exposure claims involving litigation and rehabilitation
- Ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements
- Identify subrogation of claims and negotiate settlements
- Investigate claims and gather information to determine exposure
- Manage claims through action plans to appropriate and timely resolution
- Negotiate settlements within designated authority
- Calculate and assign timely and appropriate reserves and manage reserve adequacy throughout the claim
- Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority
- Prepare necessary state filings within statutory limits
- Manage the litigation process and ensure timely, cost-effective claims resolution
- Report claims to the excess carrier and respond to requests for directions professionally and timely
Requirements
What you’ll need- California workers' compensation experience
- Experience handling litigated and high-exposure claims
- Understanding of California jurisdictional requirements
- Ability to manage claims through investigation, benefit determination, settlement negotiation, and resolution
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- Four (4) years of California workers compensation claims management experience or equivalent combination of education and experience required
- California jurisdictional knowledge required
- SIP required or must be obtained within one year of hire date
- Clear and conceptual thinking ability
- Excellent judgment, troubleshooting, problem solving, analysis, and discretion
- Ability to handle work-related stress and multiple priorities simultaneously
- Ability to meet deadlines
- Computer keyboarding
- Hearing, vision and talking
Benefits
Comp & perks- Flexible work schedule
- Referral incentive program
- Career development and promotional growth opportunities
- Medical, dental, vision, 401K and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account
- Other additional voluntary benefits
- Reasonable accommodations where applicable and appropriate