Senior Claims Examiner (Wc) (California Remote)

W.R. Berkley Corporation Walnut Creek , CA 94596

Posted 2 weeks ago

Company Details

At Berkley Entertainment, our team's industry experience and collaborative approach leads to great client solutions and this is by design. We are here to assist with customizing products and services that are tailored to respond to each client's unique exposures.

Our business model is focused on you and providing peace of mind the way we operate, the team we have built, current and planned future products, and the way we interact with clients will meet or exceed your expectations.

Responsibilities

Under limited supervision, reviews, evaluates, negotiates and processes WC Claims of serious to significant complexity, makes recommendations for resolution, and litigation management as appropriate. Has contact with agents, policy holders, defense and applicant attorneys. This position will be working in the Sports Division of the Claims Department. The position is located in either our Irving, TX office or California, depending on residence of the employee.

Major Responsibilities:

  • Responsible for the day to day management of serious to complex workers compensation claims.

  • Conduct initial investigation to confirm coverage is in place for the loss and that the loss itself is compensable per California specific requirements, make quality, prompt contacts with employer, claimant, doctor and any witnesses, document and confirm initial diagnosis and prognosis.

  • Ensure that the claim is adequately reserved, review and pay medical bills and expense bills timely and accurately, recognize and evaluate each case for subrogation potential, recognize potential fraud cases, document return to work and light duty efforts, accurately calculate, code and issue indemnity payments, promptly and accurately complete required internal Large Loss reports.

  • Proactively manage all litigated claims by clearly documenting the litigation plan and budget, retaining competent counsel, communicating with counsel on a regular basis and clearly documenting the litigation action plan and strategy.

  • Participate in claim reviews, which may require some travel.

Qualifications

Qualifications:

  • Bachelor's degree in business insurance or related field with at least 5 to 10 years of experience in investigating and adjusting workers compensation claims.

  • Texas or California Adjuster License required in area of adjusting specialty.

  • Extensive understanding of WC Statutory benefits and state regulatory requirements in California preferred.

  • Demonstrates strong written and oral communications skills.

  • Ability to draft communications that are clear, concise, complete and professional.

  • Negotiation skills mandatory, and ability to interact with all levels of the organization.

  • Demonstrates organizational skills while working on multiple projects.

  • Working knowledge of Excel, Word, and general computer skills.

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Senior Claims Examiner (Wc) (California Remote)

W.R. Berkley Corporation