Sr Claims Specialist HI

A Brief Overview

Investigate, analyze, and determine the extent of company's liability concerning Claims and attempt to effect settlement with claimants.

Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of Claims within a certain monetary limit.

All tasks are to be performed with the goal of demonstrating Zenith's superior Claims handling expertise.

What you will do

• Under limited direction, works within broad limits and authority on highly complex assignments.
• Responsible for Claims management of assigned case load within guidelines of published performance standards.
• Opens new Claims, completes three-point contact, and performs needed investigations to determine compensability as well as possible subrogation or apportionment, according to state and / or Zenith’s timeframes and guidelines.
• Sets appropriate reserves according to Zenith’s timeframes and guidelines.
• Follows appropriate procedures for system documentation to preserve data integrity.
• Monitors and maintains accuracy of reserves over the life of the claim; when new information is received re-evaluates and recommends reserves according to Zenith’s standards.
• Creates and executes action plans needed to bring case to closure.
• Completes detailed settlement evaluations and recommends appropriate settlement value, within authority; negotiates claim settlements with injured workers and / or injured workers’ attorneys.
• Maintains regular contact with injured workers, employers and agents to develop positive relationships and establish credibility.
• Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
• Works productively and harmoniously with others on a consistence basis.
• Respond positively to direction and criticism of performance.
• Consistently maintain professional and appropriate demeanor.
• Perform other duties as assigned.

Education Qualifications

• High School Diploma Or equivalent required
• Bachelor’s Degree equivalent combination of training / experience required.

Experience Qualifications

• 5+ Years Workers’ Compensation Claims handling experience required.
• Active Hawaii Work Comp Adjuster license required.

Skills and Abilities

• Advanced technical workers’ compensation Claims knowledge.
• Strong verbal and written communication skills with emphasis on telephone communication required.
• Strong math and reading skills required.
• Meets all state regulatory standards regarding licensing, continuing education, and other requirements.

The expected salary range for this position is $92,518.50 - $115,648.13. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law.

Qualifications may warrant placement in a different job level.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability.

To request an accommodation, contact a Human Resources Representative at Zenith Insurance Company.