WC Sr. Claims Examiner

Berkley Risk (a Berkley Company); McKinney (TX); On-site; USD 90,000 - 100,000; Full time

Benefits offered by this job

Health benefits

401(k) & profit sharing

Paid time off

Job summary

Berkley Risk (a Berkley Company) is seeking a detail-oriented Workers' Compensation Claims Analyst to manage complex caseloads, including disability cases and litigation support. You will ensure compliance with regulations and collaborate with clients, legal counsel, and healthcare professionals to resolve claims efficiently.

The role requires strong analytical skills, excellent customer service, and proficient PC use within a claims processing environment. Occasional travel may be required.

Qualifications

• Demonstrated working knowledge of workers’ compensation administration rules/laws.
• Excellent communication and presentation skills.
• Must be able to interface with clients, legal counsel, health care professionals, etc.
• Good math and analytical ability.
• Excellent customer service skills.
• Basic PC skills and a working knowledge of Windows environment. Experience with a client/server based claims processing system.

Responsibilities

• Investigate claims and decide on compensability and general claims management for assigned files.
• Document claim handling activities; create and document action plans.
• Establish appropriate case reserves.
• Manage medical treatment and disability while helping the injured worker return to work.
• Comply with performance guidelines.
• Identify loss trends and communicate to supervisor/clients.
• Use diary system to issue indemnity payments and manage claims.
• Investigate and manage subrogation and settlements.
• Handle coverage B or conflict-of-interest cases as assigned.
• Address customer complaints professionally.
• Participate in client claim reviews as scheduled or requested.
• May perform other functions as assigned.

Skills

Workers' comp rules

Communication

Client interface

Math & analytics

Customer service

Windows pc skills

Education

BA/BS + 3 years experience

Alternative credential path

Tools

Claims processing system

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

Responsible for managing a caseload consisting of incoming and more complex workers’ compensation cases including extended disability cases, litigation, employer’s liability claims, and assigned claims. Responsible for all technical aspects of claim management for assigned files including compliance with all established performance guidelines.

• Investigate claims and make appropriate decisions regarding claim compensability and general claims management for assigned files.
• Document claim handling activities; create and document action plans.
• Establish appropriate case reserves.
• Actively manage medical treatment and disability while assisting the injured worker to return to work.
• Comply with all performance guidelines.
• Identify loss trends and communicate to supervisor and/or clients.
• Use automated diary system to issue indemnity payments and for claims management.
• Investigate and manage claim subrogation and negotiate settlements.
• Manage coverage B or conflict of interest cases as assigned.
• Address customer complaints and inquiries in an exemplary and professional manner.
• Participate in client claim reviews when scheduled or requested.
• May perform other functions as assigned.

Qualifications

• Demonstrated working knowledge of workers’ compensation administration rules/laws.
• Excellent communication and presentation skills.
• Must be able to interface with clients, legal counsel, health care professionals, etc.
• Good math and analytical ability.
• Excellent customer service skills.
• Basic PC skills and a working knowledge of Windows environment. Experience with a client/server based claims processing system.

Education

• BA/BS degree with three years’ experience. Experience must include litigation, subrogation and complex medical/legal issues; or two years post-high school education and five years’ experience in workers compensation claims management.

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: $$90,000 - $100,000

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.

Additional Requirements

• Travel: Occasional travel.