W.R. Berkley Corporation Santa Ana , CA 92701
Posted 1 week ago
Company Details
BerkleyNet is an innovative workers compensation insurance provider that does all of our business online. Our Goal? To make doing business "Ridiculously Fast. Amazingly Easy."
Responsibilities
As a Senior Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of an inventory of lost time and catastrophic workers' compensation injury claims in multiple jurisdictions.
Investigate workers' compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due
Calculate and set timely financial reserves and proactively manage reserve adequacy throughout claim lifecycle
Record and code injured worker demographics, job information and accident information in company's claims management system and files necessary forms with state regulatory agencies
Issue timely payments to injured workers, medical providers and service vendors
Coordinate and actively manage medical treatment of injured workers to ensure timely rehabilitation
Negotiate settlements of claims within designated authority with injured workers and attorneys
Serve as the team's subject matter expert of the Workers' Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions
Identify and manage subrogation, Second Injury Fund and joint coverage recovery opportunities
Regularly communicate claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful manner
Notify management and develop reports for large exposure claims and comply with reinsurance reporting requirements
Manage the claims litigation process to ensure timely and cost-effective claims resolution
Monitor the expenses and effectiveness of managed care and investigation vendors
Periodically travel to attend hearings, conferences and training sessions
Attend and participate in claim file reviews with management and defense attorneys
Coordinate and lead special projects or processes as assigned by management
Assists with oversight and supervisory duties when the team supervisor is unavailable or as assigned by supervisor
Support management with training and staff development
Support management with vendor management activities
Continuously strives to improve our product and business results through innovation
Obtain and maintain adjuster license(s) in assigned jurisdictions
Qualifications
Core Competencies
Action Oriented
Balanced Approach
Creative Thinking
Prioritization of Work
Quality Decision Making
Additional Skills & Qualifications
3 - 5 years of experience handling workers' compensation claims
Excellent written and verbal communication skills
Strong interpersonal and relationship building skills
Exceptional time management and organization skills
Strong analytical and critical thinking skills
Ability to work independently and strategically problem solve
Ability to diplomatically manage conflict
Ability to develop relationships within the organization and work effectively across departments
Strong discretion and integrity in dealing with highly confidential and sensitive information
Detail oriented
Education
Travel Requirements
Additional Company Details
The Company is an equal employment opportunity employer
Additional Company Details
The Company is an equal employment opportunity employer We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. Salary Range: 75k-90k The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
Additional Requirements
While performing the duties of this job, the employee is regularly required to be seated for sustained periods of time; be able to use a keyboard; pick-up, pinch, or twist objects; must be able to communicate information accurately; distinguish sounds at normal levels and be able to receive information orally. The employee is occasionally required to move about the office to accomplish tasks; reach in any direction; raise or lower objects or move objects from place to place; and hold onto objects. Occasionally, the employee may need to move or exert force up to ten (10) pounds. The employee is regularly required to operate a computer and other office equipment, including a phone, copier and printer.
Sponsorship Details
Sponsorship not Offered for this Role Responsibilities As a Senior Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of an inventory of lost time and catastrophic workers' compensation injury claims in multiple jurisdictions.
Investigate workers' compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due
Calculate and set timely financial reserves and proactively manage reserve adequacy throughout claim lifecycle
Record and code injured worker demographics, job information and accident information in company's claims management system and files necessary forms with state regulatory agencies
Issue timely payments to injured workers, medical providers and service vendors
Coordinate and actively manage medical treatment of injured workers to ensure timely rehabilitation
Negotiate settlements of claims within designated authority with injured workers and attorneys
Serve as the team's subject matter expert of the Workers' Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions
Identify and manage subrogation, Second Injury Fund and joint coverage recovery opportunities
Regularly communicate claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful manner
Notify management and develop reports for large exposure claims and comply with reinsurance reporting requirements
Manage the claims litigation process to ensure timely and cost-effective claims resolution
Monitor the expenses and effectiveness of managed care and investigation vendors
Periodically travel to attend hearings, conferences and training sessions
Attend and participate in claim file reviews with management and defense attorneys
Coordinate and lead special projects or processes as assigned by management
Assists with oversight and supervisory duties when the team supervisor is unavailable or as assigned by supervisor
Support management with training and staff development
Support management with vendor management activities
Continuously strives to improve our product and business results through innovation
Obtain and maintain adjuster license(s) in assigned jurisdictions
W.R. Berkley Corporation