Claim representative Jobs in Fresno, CA

Senior Claims Examiner Workers Compensation (California)

This is an exciting opportunity to join a global leader in claims management and make a meaningful impact through your expertise. Excellent Crawford Benefits Supporting Financial, Physical & Mental Wellness Great Bonus Opportunity Generous Employee Referral Bonus Program Access to Multiple Employee Discounts We're looking for a Senior Claims Examiner Workers Compensation (California) with a passion for claims management to join our team! SIP certification is required Proven experience handling California Workers Compensation claims Strong background in managing advanced, large-loss, and complex cases.

Role Overview: Investigate and settle advanced, large-loss, and complex claims promptly and equitably with minimal supervision. Work within established authority on moderate-to-difficult claims, reviewing coverages, determining liability/compensability, collecting statements and essential information, and settling claims using best practices. Evaluate and set reserves using independent judgment, support litigation preparation with supervisors and defense attorneys, and contribute to team development through training and mentorship.

Responsibilities: Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted. Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel. Analyzes claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements. Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits. Develops subrogation and third party recovery potential and follows reclaim procedures. Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.

Qualifications: Bachelor's degree or equivalent experience required. Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization. Ability to work independently while assimilating various technical subjects. Strong written and oral communication, negotiation and presentation skills. Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects. Effective advanced interpersonal skills to effectively interact with all levels of internal and external clients. Industry Designations: Preferred: IIA, AIC, AEI, and/or CPCU. License Requirements: Per State or Jurisdictional requirements. Workers Compensation (WC) Adjuster License required according to jurisdictional requirements.

About Us: Because a claim is more than a number - it's a person, a child, a friend. It's anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community - one claim at a time. At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We're looking for the next generation of leaders to take this journey with us. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at When you accept a job with Crawford, you become a part of the One Crawford family. And as part of the One Crawford family, we offer a comprehensive Total Rewards package to our employees to assist with their financial, health/wellness, continuing education/training and other needs: Competitive base pay Bonus/Incentive Pay and other Performance-Based Rewards, if applicable. We offer a well-rounded benefits package that encourages wellness and helps our employees to be an educated healthcare consumer. The core benefits* offered include: Medical, Dental and Vision Plans Prescription Drugs HSA, HRA, and FSA Accounts Paid Holidays, Vacation and Sick Leave 401(k) Retirement Plan Tuition Assistance Paid Parental Leave Supplemental Health Benefits Other Benefits currently available at no cost include: Enhanced Mental Health Support Virtual Physical Therapy Caregiving Services Life Assistance Program Training programs that promote continuous learning and career progression while enhancing job performance. Sustainability programs that give back to the communities in which we live and work. A culture of respect, collaboration, entrepreneurial spirit and inclusion. Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.