Sr. Claims Representative - Workers Compensation CA, NV, AZ

BerkleyNet (a Berkley Company); California (MO); Remote; USD 65,000 - 95,000; Full time

Job summary

An innovative insurance provider is seeking a Sr. Claims Representative specializing in Workers Compensation for the CA, NV, and AZ jurisdictions. This role involves investigating claims, managing financial reserves, and ensuring timely rehabilitation for injured workers. You will utilize your exceptional communication and analytical skills to negotiate settlements and maintain compliance with regulatory standards. Join a forward-thinking company that values innovation and offers competitive compensation and benefits, including health and wellness programs, to foster a supportive work environment.

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off

401(k)

Profit Sharing

Wellness Programs

Qualifications

• Excellent written and verbal communication skills are essential.
• Strong analytical and critical thinking abilities required.

Responsibilities

• Investigate workers’ compensation claims and determine compensability.
• Coordinate medical treatment and negotiate settlements with injured workers.

Skills

Communication Skills

Interpersonal Skills

Time Management

Analytical Thinking

Conflict Management

Attention to Detail

Education

Bachelor's Degree

Job description

Sr. Claims Representative - Workers Compensation CA, NV, AZ

2 days ago - Be among the first 25 applicants

Company Details
BerkleyNet is an innovative workers compensation insurance provider that does all our business online. Our goal? To make doing business “Ridiculously Fast. Amazingly

Responsibilities

• 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 the claim lifecycle.
• Record and code injured worker demographics, job information, and accident details in the company’s claims management system and file 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 within designated authority with injured workers and attorneys.
• Demonstrate a working knowledge of the Workers’ Compensation Act, adjudication process, and regulatory compliance in assigned jurisdictions.
• Identify and manage subrogation, Second Injury Fund, and joint coverage recovery opportunities.
• Communicate claim activity and status updates professionally and tactfully to policyholders, injured workers, and other interested parties.
• Respond promptly to communications from all parties involved.
• Notify management and develop reports for large exposure claims; comply with reinsurance reporting requirements.
• Manage the claims litigation process for timely and cost-effective resolution.
• Monitor expenses and the effectiveness of managed care and investigation vendors.
• Participate in special projects assigned by management.
• Travel periodically for hearings, conferences, and training.
• Participate in claim file reviews with management and defense attorneys.
• Strive to improve products and business results through innovation.
• Obtain and maintain necessary adjuster licenses in assigned jurisdictions.

Qualifications

• Excellent written and verbal communication skills.
• Strong interpersonal and relationship-building skills.
• Exceptional time management and organizational skills.
• Strong analytical and critical thinking abilities.
• Ability to work independently and solve problems strategically.
• Diplomatic conflict management skills.
• Ability to develop internal relationships and collaborate across departments.
• Discretion and integrity when handling confidential information.
• Attention to detail.

Education

• Bachelor’s degree or equivalent insurance industry experience.

Additional Details

The company is an equal employment opportunity employer. For candidates with jurisdiction experience in CA, AZ, & NZ claims, remote work may be considered. We do not accept unsolicited resumes from external recruiting firms. We offer competitive compensation and benefits including health, dental, vision, life, disability, wellness programs, paid time off, 401(k), and profit-sharing. Salary range: $65,000 - $95,000, determined by experience and other factors.

Sponsorship

Sponsorship is not offered for this role.