WC Claims Examiner

Berkley Risk (a Berkley Company); Saint Paul (MN); On-site; USD 55,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

401(k) plan

Paid time off

Profit sharing

Job summary

Berkley Risk (a Berkley Company) in Minnesota is seeking a workers’ compensation claims adjudicator. You will handle investigations, reserves, subrogation, wage benefits, and return‑to‑work discussions.

The role requires 1+ year of experience, solid knowledge of workers’ compensation rules, and strong math and customer service skills. A college degree or equivalent experience is acceptable. Competitive benefits are offered.

Qualifications

• 1+ years of professional working experience.
• Preferred 1–2 years workers’ compensation claim processing experience.
• Experience with medical-only, lost-time and litigated claims.
• Knowledge of workers’ compensation administration rules/laws.
• Strong math and analytical abilities.
• Excellent oral and written communication skills.
• Outstanding customer service skills.

Responsibilities

• Investigate and handle workers’ compensation files including lost time, litigation, and long‑term exposure per 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.

Skills

Mathematical ability

Analytical skills

Oral and written communication

Customer service

Detail oriented

Problem solving

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.

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 claims 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+ years of professional working experience.
• Preferred 1 – 2 years 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

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: $55,000 - $65,000

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.