Claims Examiner Trainee

Bhhc; San Diego (CA); Hybrid; USD 35,516 - 50,583; Full time

Benefits offered by this job

WFH Hybrid schedule

Free gym in building

Tuition assistance

Paid time off

Excellent benefits

Health & wellness reimbursement

Job summary

Berkshire Hathaway Homestate Companies is seeking a detail-oriented Workers’ Compensation Claims Adjuster to start in a training program and advance to managing a caseload from inception to resolution.

The role emphasizes investigation, medical terminology, negotiation, and strategic planning, with hybrid work options and a comprehensive benefits package.

Qualifications

• High school diploma or equivalent; bachelor’s degree preferred.
• Strong verbal and written communication skills.
• Spanish language ability preferred.
• Excellent interpersonal and customer service abilities.
• Ability to prioritize in a fast-paced environment.
• Basic math skills for reserves calculation.
• Proficiency in MS Word, PowerPoint, Excel, and Outlook.

Responsibilities

• Completes classroom training introducing workers’ compensation claims handling strategies, medical terminology, and legal concepts.
• Learns investigative and persuasive communication, negotiation, decision-making, and strategic planning; learns to review medical records.
• Conducts and directs investigation of reported claims to determine coverage, compensability and severity and to gather all relevant information.
• Calculates reserves for each claim and adjusts as needed per authority guidelines.
• Develops and updates a plan of action for the successful resolution of each claim.
• Assigns tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly.
• Reduces fraud through early identification and escalation.
• Communicates with clients, medical providers, and injured workers.
• Prepares timely settlement recommendations and negotiates settlements within authority.
• Coordinates actions of attorneys, nurse case managers, and investigators for resolution.

Skills

Verbal communication

Written communication

Spanish language (preferred)

Interpersonal skills

Customer service

Multitasking

Time management

Microsoft Word

PowerPoint

Excel

Outlook

Education

High school diploma

Bachelor's degree preferred

Tools

Microsoft Word

PowerPoint

Excel

Outlook

Job description

Overview

Berkshire Hathaway Homestate Companies is seeking bright individuals to begin a challenging, yet rewarding career path as a Workers’ Compensation Claims Adjuster. This role trains through a Claims Training program and leads to management of a caseload of workers’ compensation claims from inception to resolution, including initial investigation, analysis, strategic planning, medical care management, legal process, and client relations.

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 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.

Qualifications

• 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

Benefits & Work Arrangements

• 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.