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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing complex workers' compensation claims, including investigation, negotiation, and litigation processes, while ensuring compliance with California jurisdictional requirements. Proficient in claims management, reserve calculations, and maintaining accurate documentation and coding.
Highest-signal resume keywords
Claims Management ExperienceCalifornia Jurisdictional KnowledgeSIP CertificationClaims Investigation and NegotiationLitigation Management
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 AnalysisReserve CalculationBenefit Payment ProcessingClaims Settlement NegotiationCost Containment TechniquesSubrogation ManagementState Filings PreparationClaims CodingVendor CoordinationLitigation Process Management
Soft Skills
Professional CommunicationClient Relationship Management
Certifications & Qualifications
SIP CertificationProfessional Certification
Industry Keywords
Workers' CompensationClaims ExposureClaim RecoveriesSecond Injury FundSocial Security OffsetsMedicare Offsets
About the role
Key responsibilities & impact- Analyze complex or technically difficult workers' compensation claims to determine benefits due
- Investigate claims and gather information to determine claim exposure
- Manage claims through action plans to timely and appropriate resolution
- Negotiate claim settlements within designated authority
- Calculate and assign reserves and manage reserve adequacy throughout the claim lifecycle
- Calculate and pay benefits, approve claim payments and adjustments, and settle claims within authority
- Prepare necessary state filings within statutory limits
- Manage litigation processes for timely and cost-effective resolution
- Coordinate vendor referrals for investigation and litigation management
- Apply cost containment techniques and strategic vendor partnerships
- Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets
- Report claims to excess carriers and respond to requests for direction
- Communicate claim activity and processing with claimants and clients
- Maintain professional client relationships
- Ensure claim files are documented and claims coding is correct
- Refer cases to supervisors and management when appropriate
Requirements
What you’ll need- Five (5) years of claims management experience or equivalent combination of education and experience required
- California jurisdictional knowledge required
- SIP required or must be obtained within one (1) year of employment
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- Ability to analyze and process complex or technically difficult workers' compensation claims
- Knowledge of claims investigation, reserves, benefit payments, settlements, litigation, subrogation, recoveries, and cost containment
- Ability to prepare necessary state filings within statutory limits
- Ability to manage claims and litigation processes
- Ability to communicate professionally with claimants and clients
- Ability to maintain properly documented claim files and correct claims coding
Benefits
Comp & perks- Flexible work schedule
- Referral incentive program
- Career development and promotional growth opportunities
- Medical, dental, and vision benefits
- 401(k) and matching
- Paid time off (PTO)
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
- Work-life balance
- Professional development opportunities
- Flexibility and autonomy in daily work, location, and career path