WC Claims Examiner

Berkley Risk (a Berkley Company); Saint Paul (MN); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Health

Dental

Vision

Life

Disability

Wellness

Paid time off

401(k)

Profit-sharing plans

Job summary

Berkley Risk (a Berkley Company) in Minnesota is seeking a workers' compensation claims professional to handle adjudication and investigations. You will work with medical-only, lost-time and litigated claims, applying established guidelines and collaborating with clients and state agencies.

The role emphasizes accuracy in reserves, wage loss calculations, subrogation and settlements, with opportunities for professional growth in a supportive benefits package.

Qualifications

• 1–2 years minimum workers' compensation claim processing experience.
• Experience with medical-only, lost-time and litigated claims.
• Demonstrated working knowledge of workers' compensation administration rules/laws.
• Good to excellent math and analytical ability.
• Good to excellent oral and written communication skills.
• Excellent customer service skills.

Responsibilities

• Perform workers' compensation claims adjudication and investigations.
• Investigate all types of workers' compensation files within predetermined claim-handling guidelines.
• Initiate return-to-work discussions with the employer.
• Establish timely and appropriate case reserves.
• Investigate and manage subrogation and negotiate settlements.
• Use automated diary system to issue indemnity benefits and provide claim management.
• Accurately calculate and pay wage loss and other benefits.
• Assign rehabilitation and monitor costs and outcomes.
• Document all action plans and evaluations for claim resolution.
• Interact with clients, state agencies, attorneys and other providers.
• Address customer complaints and inquiries in a professional manner.
• Achieve specific performance outcomes related to quality and quantity of work.

Skills

Workers' comp knowledge

Analytical skills

Communication skills

Customer service

Mathematical ability

Claim processing experience

Education

College degree or relevant experience

Job description

Company Details

We're a member company of W. R. Berkley Corporation, an A. M. Best A+ rated Fortune 500 holding company. Berkley is comprised of individual operating units that serve a defined insurance market segment. Berkley Risk is focused on providing self-insured entities program administration services and insurance operations which can include taking or sharing risk using Berkley paper. This capability allows us to customize both an insurance company option and a purely administrative option for our customers.

Company Details

We're a member company of W. R. Berkley Corporation, an A. M. Best A+ rated Fortune 500 holding company. Berkley is comprised of individual operating units that serve a defined insurance market segment. Berkley Risk is focused on providing self-insured entities program administration services and insurance operations which can include taking or sharing risk using Berkley paper. This capability allows us to customize both an insurance company option and a purely administrative option for our customers.

Responsibilities

To perform workers' compensation claims adjudication and investigation. Responsible for all technical aspects of claim management for assigned including compliance with all established performance guidelines.

• Properly investigate and handle all types of workers' compensation files including lost time, litigation and long-term exposure within predetermined claim-handling guidelines.
• Initiate return-to-work discussions with the employer and effect return-to-work for the injured worker.
• Establish timely and appropriate case reserves.
• Investigate and manage subrogation and negotiate settlements.
• Use automated diary system to issue indemnity benefits and provide claim management.
• Accurately calculate and pay wage loss and other benefits.
• Assign rehabilitation and monitor costs and outcomes.
• Document all action plans and evaluations for claim resolution.
• Maintain organized electronic files.
• Interact with clients to establish/improve communication and service capabilities.
• Interact and communicate with state agencies, attorneys and other providers.
• Address customer complaints and inquiries in an exemplary and professional manner.
• Achieve specific performance outcomes related to quality and quantity of work as established by management.
• Provide cost containment for individual claim and overall claim costs for account to achieve account profitability.
• Define medical and rehabilitation payment parameters staff.
• May perform other functions as assigned.

Qualifications

• 1 - 2 years minimum workers' compensation claim processing experience.
• Experience must include handling of medical-only, lost-time and litigated claims.
• Demonstrated working knowledge of workers' compensation administration rules/laws.
• Good to excellent math and analytical ability.
• Good to excellent oral and written communication skills.
• Excellent customer service skills.

Education

• College degree or relevant experience.

Additional Company Details

Important Outside Agency Notice:

Only solicited resumes/candidate profiles that are submitted by a Berkley Preferred Agency Partner that have been requested by Berkley Internal Recruiting to engage in a particular search will be subject to the payment of Agency fees as defined in the formal agency agreement. Any unsolicited resumes/candidate profiles are not subject to payment of the agency fees.

The company offers a competitive compensation plan and robust benefits package for full time regular employees.

• Health
• dental
• vision
• life
• disability
• wellness
• paid time off
• 401(k)
• profit-sharing plans

Base salary & Benefits include Health, dental, vision, life, disability, wellness, paid time off, 401(k) and profit-sharing plans.

Salary Range: $60k-$80k

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.