Senior Claims Specialist

Title: Senior Claims Specialist, Workers Comp.

Location: ORANGE, California, United States

Department: Claims

Category

Claims

Type

Regular

Division

Commercial Lines

Job Description:

Crum & Forster Company Overview

Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry.

Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2025 Great Place to Work® Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion.

C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. 

Examines claims data and conducts investigations into routine and moderately complex claims to determine coverage, compensability, subrogation and benefits under moderate supervisory direction. Adjusts and manages claims within the limit of assigned authority.

What you will do for C&F:

• Must be well versed in California Compensation statute claims.
• Receives lost time and complex medical only assignments. Verifies and determines applicability of coverage. Initiates 24-hour contact with employer, employee and 48-hour contact with attending physician.
• Handles catastrophic claims with supervisory oversight.
• Conducts telephone investigations as required by company claims handling manual and procedures.
• Evaluates and adjusts claims within the limits of authority.
• Consults with Claim Manager on those claims where assistance and consultation is needed.
• Makes assignments to nurse case management when indicated, monitoring their billing and performance.
• Sets reserves for anticipated exposure up to authority limits.
• Completes mandatory Reserve Worksheets. Establishes reserves requiring complex analysis with lifetime pharmacy and cost inflation.
• Coordinates return to work (RTW) and sets target dates.
• Maintain diaries on maximum three (3) month intervals.
• Documents files in the claims system.
• Reviews medical bills for causal relationship, medical bill charges for appropriateness and approves payments.
• Adheres to special account handling (SHI) instructions.
• Attends account meetings by telephone and in-person.
• Manages litigation on the files.

What you will bring to C&F:

• College degree, B.A. or equivalent experience.
• 3+ years of experience handling workers compensation claims.
• Strong organizational skills.
• Good time management skills.
• Foreign language communications a plus.
• Excellent verbal and written communication skills are essential.
• Strong aptitude and knowledge of Microsoft Office programs and the ability to quickly learn new programs.
• Will abide by departmental policies and procedures, including authority levels, to comply with C&F’s risk management controls.
• What C&F will bring to you
• Competitive compensation package
• Generous 401K employer match
• Employee Stock Purchase plan with employer matching
• Generous Paid Time Off
• Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeing
• A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path
• A dynamic, ambitious, fun and exciting work environment
• We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community

At C&F you will BELONG

If you require special accommodations, please let us know. We value inclusivity and diversity. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, please let us know

 For California Residents Only:  Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit https://www.cfins.com/onlineprivacypolicy/ca/noticeatcollection/  for more information.

Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws.  Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $55,800.00 to a maximum of $104,900.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee’s contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs.

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