Senior Claims Examiner

Preferred Employers Insurance (a Berkley Company); San Diego (CA); On-site; USD 80,000 - 125,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Wellness program

Paid time off

401(k) and profit-sharing

Job summary

Preferred Employers Insurance, A Berkley Company, seeks a Senior Workers’ Compensation Examiner to analyze and manage complex California workers’ compensation claims, reviewing coverage, compensability, and claim appropriateness in line with company standards and state regulations.

The role involves settlements within authority, reserve management, litigation coordination, and cost-control via vendor partnerships, requiring strong communication, negotiation, and analytical skills in a fiduciary

Qualifications

• Bachelor’s degree preferred.
• 5+ years claims management experience.
• Professional certification as applicable to workers’ compensation required.
• WCCP certification preferred.
• Strong written and verbal communication skills.
• Strong organizational skills.
• Strong negotiation skills.
• Strong analytical and interpretive skills.
• PC literate.

Responsibilities

• Analyze and process workers’ compensation claims and determine exposure.
• Negotiate settlements up to authority level and issue payments.
• Manage complex or technical claims.
• Assign reserves and maintain adequacy throughout the life of the claim.
• Coordinate litigation and vendor referrals for investigation and/or litigation management.
• Maintain professional client relationships.
• Ensure timely and cost-efficient claims resolution.

Skills

Written communication

Verbal communication

Organizational skills

Negotiation skills

Analytical skills

Education

Bachelor’s degree

Job description

Company Details

Preferred Employers Insurance, A Berkley Company specializes in providing workers’ compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid-Larger Businesses and Group Association Members (Programs). The company’s distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company.

Company URL: https://www.peiwc.com

The company is an equal opportunity employer.

Responsibilities

The Senior Workers’ Compensation Examiner is responsible for the analysis and management of complex workers’ compensation claims. This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims. The position will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. Acts in a fiduciary role on behalf of policyholders, negotiates claim settlements and manages subrogation. Senior Claims Examiner’s conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. The Senior Workers’ Compensation Examiner is expected to function with a degree of competency. The use of sound judgment coupled with consistent results is expected.

Key Function Include But Are Not Limited To

• Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure on the claim.
• Negotiates settlement of claims up to designated authority level and makes claims payments.
• Processes complex or technically difficult claims.
• Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.
• Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
• Prepares necessary state filings within statutory limits.
• Actively manages the litigation process; ensures timely and cost-effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
• Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
• Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner.
• Frequently communicates with all appropriate parties involved with the claim.
• Refers cases as appropriate to management.
• Maintains professional client relationships.
• Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.

Qualifications

• Bachelor’s degree preferred
• 5+ years claims management experience.
• Professional certification as applicable to workers’ compensation required
• WCCP PreferredIn depth knowledge of appropriate insurance principles and laws for workers’ compensation.
• Strong written and verbal communication skills.
• Strong organizational skills.
• Strong negotiation skills
• Strong analytical and interpretive skills.
• PC literate.
• Professional certification as applicable to workers’ compensation required.

Additional Company Details

We do not accept any unsolicited resumes from external recruiting agencies or firms.

Benefits

The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include:

• Base Salary Range: $80,000 – $125,000 annually
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.

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.

Sponsorship Details

Sponsorship not Offered for this Role