Senior Claims Examiner, Workers' Compensation

Senior Claims Examiner

At Gallagher, we help clients face risk with confidence because we believe that when businesses are protected, they're free to grow, lead, and innovate. You'll be backed by our digital ecosystem : a client-centric suite of consulting tools making it easier for you to meet your clients where they want to be met. Advanced data and analytics providing a comprehensive overview of the risk landscape is at your fingertips. Here, you're not just improving clients' risk profiles, you're building trust. You'll find a culture grounded in teamwork, guided by integrity, and fueled by a shared commitment to do the right thing. We value curiosity, celebrate new ideas, and empower you to take ownership of your career while making a meaningful impact for the businesses we serve.

Keenan is a leading insurance brokerage and consulting firm serving hospitals, public agencies, and California school districts. Specializing in employee benefits, workers' compensation, loss control, financial services, and property & liability, Keenan is committed to delivering innovative solutions that protect and empower the communities we serve. As part of Gallagher, a global leader in insurance, risk management, and consulting, you'll be joining a team that's passionate about helping individuals and organizations thrive.

Job Responsibilities

The Senior Claims Examiner will administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation. This is a remote position located in California.

• Maintain current diary.
• Identify, prevent and mitigate potential penalties.
• Update claim notes in computer.
• Provide timely reporting of excess files to the Reinsurance Manager.
• Report SIU / Fraud.
• Identify and pursue subrogation.
• Complete Rehab forms / benefit notices / SJDB / RTW form.
• Refer all PRIME deletions only to office designee.
• Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim.
• Prepare for and attend file reviews.
• Accept or deny delayed claims within 90 days.
• Request settlement authorization / notification within 30 days of a final P&S report and prior to the MSC date.
• Complete Stipulation and / or Compromise and Release paperwork.
• Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually.
• Prepare legal referrals, provide direction to and monitor defense attorney.
• Return all phone calls within 24 hours.
• Complete instruction sheets for Assistant / Technician / Claims entry clerk.
• Review mail daily.
• Correct error report daily.
• Maintain client / claimant satisfaction.
• Update Unit Stat forms.
• Oversee new set-ups, reserves and instruction sheets.
• Prepare cover letters to AME / defense QME, AOE / COE evaluations.
• Negotiate outstanding liens.
• Make 3-point contact.
• File Answer / Application.
• Interaction with nurse on case management.
• Other duties assigned.

Qualifications

Required : High school diploma and 5 years related claims experience required. Appropriately licensed and / or certified in all states in which claims are being handled or able to obtain the licenses / certification per local requirements. Extensive knowledge of accepted industry standards and practices. Computer experience with related claims and business software.

Preferred : Bachelor's degree preferred. Behaviors : Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges. Analytical skill necessary to make decisions and resolve complex issues inherent in handling losses. Ability to successfully negotiate the settlement and disposition of serious claims including the ability to interpret related documentation.

Compensation and Benefits

We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market / geography, complexity or scope, specialized skill set, lines of business / practice area, supply / demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. Below are the minimum core benefits you'll get, depending on your job level these benefits may improve : Medical / dental / vision plans, which start from day one! Life and accident insurance 401(K) and Roth options Tax-advantaged accounts (HSA, FSA) Educational expense reimbursement Paid parental leave Other benefits include : Digital mental health services (Talkspace) Flexible work hours (availability varies by office and job function) Training programs Gallagher Thrive program elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing Charitable matching gift program And more...

Inclusion and Diversity

Inclusion and diversity (I&D) is a core part of our business, and it's embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees' diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as "protected characteristics") by applicable federal, state, or local laws. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.