Senior Claims Representative

Berkley Small Business Solutions (a Berkley Company); San Diego (CA); Remote; USD 75,000 - 110,000; Full time

Benefits offered by this job

Health, dental, vision, life insurance

401(k) and profit-sharing

Paid time off

Wellness programs

Job summary

BerkleyNet in California is seeking a Senior Claims Representative to manage investigation, evaluation and settlement of workers’ compensation claims across jurisdictions. You will interview injured workers, witnesses and policyholders, set reserves, document details in the claims system and issue payments.

The role involves negotiating settlements within authority, coordinating medical treatment, and staying current with regulatory requirements.

Qualifications

• Bachelor's degree or equivalent insurance industry work experience.
• AIC, ARM, CCP or CPCU designation is preferred.

Responsibilities

• Investigate workers’ compensation claims by interviewing injured workers, witnesses and policyholders.
• Calculate and set timely financial reserves and manage reserve adequacy throughout the claim lifecycle.
• Record and code demographics, job and accident information in the claims system; file forms as required.
• Issue timely payments to injured workers, medical providers, and service vendors.
• Coordinate and manage medical treatment to ensure timely rehabilitation.
• Negotiate settlements within designated authority with injured workers and attorneys.
• Serve as SME on Workers’ Compensation Act, adjudication, and regulatory compliance.
• Identify and manage subrogation and recovery opportunities.
• Communicate claim activity and status to policyholders and others professionally.

Skills

Communication skills

Time management

Analytical thinking

Conflict resolution

Relationship building

Discretion

Detail oriented

Education

Bachelor's degree or equivalent

Insurance designation preferred (AIC/ARM/CCP/CPCU)

Tools

Claims management system

Job description

Company Details

BerkleyNet is an innovative workers compensation insurance provider that does all of our business online. Our Goal? To make doing business “Ridiculously Fast. Amazingly Easy.”

Responsibilities

As a Senior Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of an inventory of lost time and catastrophic workers’ compensation injury claims in multiple jurisdictions.

• Investigate workers’ compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due
• Calculate and set timely financial reserves and proactively manage reserve adequacy throughout claim lifecycle
• Record and code injured worker demographics, job information and accident information in company’s claims management system and files necessary forms with state regulatory agencies
• Issue timely payments to injured workers, medical providers and service vendors
• Coordinate and actively manage medical treatment of injured workers to ensure timely rehabilitation
• Negotiate settlements of claims within designated authority with injured workers and attorneys
• Serve as the team’s subject matter expert of the Workers’ Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions
• Identify and manage subrogation, Second Injury Fund and joint coverage recovery opportunities
• Regularly communicate claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful manner
• Notify management and develop reports for large exposure claims and comply with reinsurance reporting requirements
• Manage the claims litigation process to ensure timely and cost-effective claims resolution
• Monitor the expenses and effectiveness of managed care and investigation vendors

• Periodically travel to attend hearings, conferences and training sessions
• Attend and participate in claim file reviews with management and defense attorneys
• Coordinate and lead special projects or processes as assigned by management
• Assists with oversight and supervisory duties when the team supervisor is unavailable or as assigned by supervisor
• Support management with training and staff development
• Support management with vendor management activities
• Continuously strives to improve our product and business results through innovation
• Obtain and maintain adjuster license(s) in assigned jurisdictions

Candidates with California Workers' Compensation experience may be eligible for a remote work arrangement based on qualifications and business needs.

Qualifications

• 3 - 5 years of experience handling workers’ compensation claims
• Excellent written and verbal communication skills
• Strong interpersonal and relationship building skills
• Exceptional time management and organization skills
• Strong analytical and critical thinking skills
• Ability to work independently and strategically problem solve
• Ability to diplomatically manage conflict
• Ability to develop relationships within the organization and work effectively across departments
• Strong discretion and integrity in dealing with highly confidential and sensitive information
• Detail oriented

Education Requirement

• Bachelors’ degree or equivalent insurance industry work experience
• AIC, ARM, CCP, or CPCU insurance designation preferred

Additional Company Details

The Company is an equal employment opportunity employer. We do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. Base salary & Benefits include Health, dental, vision, life, disability, wellness, paid time off, 401(k) and profit-sharing plans. Salary Range: 75k - 110k 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.