Claims Investigator - Workers' Comp (MO)

W. R. Berkley Corporation; Saint Paul (MN); On-site; USD 49,000 - 55,000; Full time

Job summary

W. R. Berkley Corporation seeks a claims professional to investigate workers’ compensation MO claims, document handling, and process benefit decisions in a growing team in Minnesota. The role involves reviewing policies, reserving, subrogation, and coordinating with injured employees and providers.

The position requires at least two years of office experience, strong analytical and communication skills, and a willingness to learn negotiation techniques. Occasional travel may be required.

Qualifications

• Minimum of two years office experience or post-high school education.
• Ability to interpret and evaluate limited medical and limited legal concepts.
• Analysis and decision-making skills.
• Good to excellent math and analytical ability.
• Good oral and written communication skills.
• Willing to learn and apply negotiation techniques.

Responsibilities

• Investigates workers’ compensation injury/illness claims, documents claim handling, and pays and/or denies benefits in a caseload of primarily medical only (MO) workers’ compensation claims.
• Limited indemnity (disability) claims may be assigned to representatives for training purposes, at supervisor discretion.
• Provides support to the claims department.
• Investigate claims for compensability by analyzing claims-related information and applying claim handling guidelines.
• Verify active policy/coverage on new claims and determine if claim involves medical benefits only or includes exposure for lost time.
• Establish case reserves consistent with exposure on new claims. Examine reserves on a regular basis and adjust reserves if there is a significant change in exposure.
• Serve and file state forms when required.
• Investigate subrogation issues on claims, and place responsible third parties on notice of our client’s subrogation interest. Pursue subrogation or transfer file as appropriate.
• Receive and respond to telephone inquiries. This includes but is limited to contact with injured employees, employers and health care providers.
• Authorize payment of bills for reasonable and necessary medical treatment, expenses associated with claims investigations and obtaining records. Send bills and records for audit when appropriate.
• Authorize or deny medical benefits within established time frames.
• Manage caseload with assistance of computer-operated diary and maintain current diaries.
• Participate in on-going training opportunities to remain current on all aspects of claims handling and customer service.
• Ensure timely filing of regulatory documents via EDI (Electronic Data Interchange); submit applicable claims to Index Bureau Reporting (ISO) and document files as applicable.
• Provide additional levels of management and claim department operational support to include payment review/approval/input and complete scheduled or special project work as needed.
• May perform other functions as assigned.

Skills

Communication skills

Analytical ability

Math proficiency

Negotiation skills

Education

High school diploma or equivalent

Job description

W. R. Berkley Corporation seeks a claims professional to investigate workers’ compensation MO claims, document handling, and process benefit decisions in a growing team in Minnesota. The role involves reviewing policies, reserving, subrogation, and coordinating with injured employees and providers.

The position requires at least two years of office experience, strong analytical and communication skills, and a willingness to learn negotiation techniques. Occasional travel may be required.