Claims Specialist

NORCAL Mutual Insurance Company Fresno, CA
SUMMARY: The Claims Specialist serves as a critical interface between the insured and the Company for insured's with claims by maintaining responsibility for direct case investigation and management, while exercising defined, independent reserving authority and executing the resolution process as determined by the claim evaluation standards. Please note, this is a remote position; the ideal candidate will reside in the any of the following states: WA, OR, NV, AZ, UT, or NM.

Essential Functions: Individual must be able to perform each essential duty satisfactorily. The essential functions listed below are representative of the knowledge, skill, and/or ability required with or without reasonable accommodation.

The Claims Specialist may be required to do any and all of these duties for case management/ investigation of claims, depending on specific needs of the assigned unit.

* Investigates cases from initial contact to resolution including research, analysis and synthesis of all medical facts; conducts in-depth interviews; prepare detailed and comprehensive written reports; assign attorney(s) and secures consultant reviews; directs and monitors attorney work product and executes recommendations regarding case resolution.

* Confirms coverage and resolves coverage issues.

* Evaluates liability and damage information to establish consistent and appropriate indemnity and ALAE reserves. Provides required documentation.

* Communicates with reinsurers and other involved parties in monitoring and resolving cases as appropriate.

* Approves bills and controls expense functions.

* Monitors trial activities and negotiates settlements within given authority, including direct negotiation with plaintiffs and plaintiff attorneys.

* Serves as a primary contact for ongoing customer communications and services regarding claim related matters.

* Prepares and presents appropriate cases for all internal reviews.

* Attends litigation-related activities including, but not limited to, arbitrations, mediations, settlement conferences, pre-trial conferences and trials.

* Assists with various Team and Departmental projects as needed.

* Performs other duties as assigned.

Fiscal Responsibilities: None

Supervisory Responsibilities: N/A

Expenses: Employees must be able to pay for certain business expenses in advance. Examples include such items as airline tickets, rental cars, hotel deposits, seminar registrations, etc. Employees are eligible for reimbursement for such expenses through NORCAL's Expense Reimbursement Policy.

Required Driving: Proof of valid Driver's license and registration. Meet NORCAL's minimum auto insurance requirement.

Non-Essential Functions: None

Physical/Environmental Working Conditions:

* General office environment is primarily sedentary work which requires the following physical activities: standing, sitting, walking, reaching, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity.

* The employee must occasionally lift and/or move up to 10 pounds.

* Exposure to LCD on a daily basis.

* A moderate noise level is usual.

* Occasional overnight travel may be required


* BS/BA degree in business or related field, or commensurate work experience is required.

Experience Required:

* At least 5 years experience in claims handling/investigation preferred

Skills Required:

* Able to plan and carry out short and long-range activities and assign priorities.

* May be required to work independently in a telecommuting environment.

* Able to exercise independent judgment and understand and communicate complex medical and legal concepts.

* Excellent communication skills in conducting in-depth investigations with insured's and others.

* Prepare and effectively present comprehensive reports and recommendations using proper English, grammar and spelling.

* Maintain confidentiality while conducting sensitive investigations.

* Establish and maintain effective working relationships with public and other professionals.

* Proficiency in MS Office including Word, Excel, and PowerPoint.

NORCAL rewards eligible employees with competitive salaries and a superb benefits program including the following:

* Excellent Health Benefits including Medical, Dental & Vision effective on 1st day of employment

* Employee Bonus Program

* Healthcare Flexible Spending & Dependent Care Accounts

* 401(k) and 401(k) match program plus 3% non-elective employer contribution

* Wellness Reimbursement

* Adoption Assistance Program

* Education Reimbursement Program

* 7.5 hour work days – 37.5 hour work week

* 4 weeks of PTO per year at time of hire and accrued per pay period

NORCAL is an Equal Employment Opportunity Employer

This description portrays in general terms the type and levels of work performed and is not intended to be all inclusive or represent specific duties of any one individual. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

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