Claims Examiner Trainee

Berkshire Hathaway Homestate Companies - Workers Compensation Division; San Diego (CA); Hybrid; USD 43,000 - 48,000; Full time

Job summary

Berkshire Hathaway Homestate Companies - Workers Compensation Division in California is seeking a Claims Examiner Trainee to manage a caseload from inception to resolution. You will complete training and learn medical terminology, legal concepts, and claims handling strategies.

The role emphasizes investigation, analytical review, reserve calculations, settlement recommendations, and coordination with attorneys, nurses, and providers.

Qualifications

• High school diploma or equivalent required; bachelor's preferred.
• Spanish fluency preferred.
• Strong written and verbal communication.
• Ability to manage multiple tasks in fast-paced environment.
• Proficient in Microsoft Office applications.
• Knowledge of claims handling concepts is a plus.

Responsibilities

• Completes classroom training introducing workers’ compensation claims handling strategies, medical terminology, and legal concepts.
• Learns skills such as investigative and persuasive communication, negotiation, decision-making, and strategic planning. Learns to review and interpret medical records.
• Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls.
• Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
• Develops and updates a plan of action for the successful resolution of each claim.
• Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently.
• Reduces fraud through early identification and escalation.
• Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers.
• Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
• Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.

Skills

Effective communication

Spanish fluency

Interpersonal skills

Customer service

Multitasking

Organization skills

Numerical skills

Education

High school diploma

Bachelor's degree preferred

Tools

Microsoft Word

PowerPoint

Excel

Outlook

Job description

What We're Looking For

Are you searching for a unique opportunity that offers exceptional training and career growth with a dynamic and growing organization? Berkshire Hathaway Homestate Companies is searching for bright individuals looking to begin a challenging, yet rewarding career path as a Workers’ Compensation Claims Adjuster.

Upon successful completion of the Claims Training program, the Claims Examiner Trainee will be responsible for management of a caseload of workers compensation claims from inception to resolution. Responsibilities include initial investigation and analysis, strategic planning, management of medical care and legal process, and client relations. This individual will continue to build on claims knowledge and claims will increase in number and complexity.

Responsibilities

• Completes classroom training introducing workers’ compensation claims handling strategies, medical terminology, and legal concepts.
• Learns skills such as investigative and persuasive communication, negotiation, decision-making, and strategic planning. Learns to review and interpret medical records.
• Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls.
• Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
• Develops and updates a plan of action for the successful resolution of each claim.
• Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently.
• Reduces fraud through early identification and escalation.
• Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers.
• Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
• Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.

What You'd Bring To The Role

• Minimum of High School Diploma or equivalent certificate required; Bachelor’s degree from four-year college or university is preferred
• Ability to communicate effectively verbally and in writing; Spanish Fluency ability preferred
• Exceptional interpersonal and customer service skills
• Ability to manage and prioritize multiple assignments in a fast-paced environment
• Strong organization skills to ensure tasks are completed within hard deadlines
• Basic mathematical skills to calculate monetary reserves
• Knowledge of Microsoft Word, Powerpoint, Excel, Outlook

WHY YOU SHOULD APPLY

• Unparalleled financial strength and stability
• Fantastic growth and advancement opportunities
• WFH Hybrid schedule
• Free gym in building
• Generous Paid Time Off and Holidays
• Excellent Benefits (Medical, Dental, Vision, 401k, etc)
• Health and Wellness Reimbursement
• Tuition Assistance Reimbursement
• Discounts across companies such as GEICO, See’s Candies, etc.

In accordance with the California Equal Pay Act, the starting hourly wage for this job is $31.2500. This hourly wage is what the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The pay scale applies only to this position and only if it is filled in California. The pay scale may be different for other positions or in other locations.