Complex Claims Specialist - Workers' Compensation (East)

biBERK Insurance Services; Omaha (NE); Remote; USD 100,000 - 125,000; Full time

Job summary

A leading insurance provider is seeking a Complex Claims Specialist for Workers' Compensation to manage and investigate high exposure claims. This remote position requires a strong background in complex claims, active adjuster license, and excellent communication skills. The role offers competitive compensation between $100,000 and $125,000 annually, along with a robust benefits package including generous vacation time and a 401(k) plan.

Benefits

Generous vacation and sick time

401(k) with company match

Fantastic healthcare package

Tuition reimbursement after 6 months

Qualifications

• 10+ years of experience handling complex workers' compensation claims.
• Active adjuster license required.
• Experience with structured settlements and Medicare Set-Asides.

Responsibilities

• Investigate and manage high exposure Workers' Compensation claims.
• Establish and update reserves throughout the claim's life.
• Collaborate with medical providers and outside counsel.

Skills

Organizational skills

Leadership skills

Communication skills

Negotiation skills

Analytical skills

Time management skills

Education

BA/BS degree

Tools

MS Word

Excel

Job description

Complex Claims Specialist - Workers' Compensation (East)

Berkshire Hathaway Direct Insurance Company (BHDIC) is the home of commercial small business insurance products biBerk Business Insurance and THREE by Berkshire Hathaway. Our Claims Department is looking for an experienced claims specialist with a strong background in complex Workers' Compensation claims.

This role handles a caseload of highly complex/high-severity Workers' Compensation claims and requires a comprehensive knowledge of Workers' compensation regulations, laws, and best practices. Multi-state experience handling Workers' Compensation claims in the following jurisdictions is preferred: New York, New Jersey, Maine, New Hampshire, Vermont, Massachusetts, Pennsylvania, Rhode Island, Connecticut, Delaware, Maryland, Washington DC, West Virginia, Virginia, North Carolina, and South Carolina.

Location: This is a full-time remote position. This position may require occasional travel to attend mediations, trainings, and/or other related department meetings.

Job Responsibilities

• Investigate coverage, determine compensability, and manage a pending of high exposure Workers' Compensation claims involving catastrophic injuries and complex cases
• Proactively establish and update reserves throughout the life of the claim to reflect claim exposure and document supporting rationale
• Resolve claims within authority and make independent case value recommendations to senior leadership on cases which exceed authority
• Participate in reserving, pricing and strategy discussions with senior leadership
• Collaborate with outside defense counsel to effectively manage litigated files according to established litigation management guidelines
• Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills
• Ensure compliance with state and federal Workers' Compensation regulations
• Provide exceptional customer service to policyholders, agents, injured workers, medical providers, legal, and vendors
• Follow escalation and reporting requirements on claims with significant exposure
• Develop creative resolution strategies to manage losses involving complex issues, effectively utilizing appropriate internal and external resources
• Document claim files in accordance with company and regulatory guidelines
• Identify subrogation potential and red flags that require SIU involvement
• Train new team members
• Act as a technical resource to less experienced claims representatives
• Maintain continuing education requirements

Qualifications

• Active adjuster license required
• 10+ years of experience handling complex workers' compensation claims
• Excellent organizational, leadership, communication and time management skills
• Experience with structured settlements and Medicare Set-Asides
• Ability to work in a fast-paced, collaborative, virtual office environment
• Strong analytical, organizational, and time management skills
• Excellent written and verbal communication skills
• Ability to work independently and meet assigned deadlines
• Strong negotiation skills
• Ability to multi-task and effectively prioritize tasks with frequent interruptions
• Proficiency with MS Word, Excel and internet applications
• Highly attentive to details
• Able to work under pressure and execute good judgment in sensitive situations
• Advanced verbal and written communication skills are essential for interacting with internal and external stakeholders

Education

• BA/BS degree required
• AIC, SCLA, CPCU or other industry designation a plus

Some highlights of our benefits are:

• Great work environment with growth opportunity
• Competitive compensation
• Generous amounts of vacation and sick time
• Closed on major holidays
• 401(k) with company match
• A fantastic healthcare package
• Tuition reimbursement after 6 months of employment
• Service recognition after 5 years of employment

In accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided. The salary range for this position is $100,000 - $125,000 per year. Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.