Sr. Claims Representative - California Workers' Compensation
Berkley, Manassas, Virginia, United States, 22110
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
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
For highly qualified and experienced candidates, we are open to considering remote work arrangements for individuals who can travel as needed.
Qualifications
3 - 5 years of experience handling workers’ compensation claims
Experience with California 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
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 range: 75k-100k Benefits include: Health, dental, vision, life, disability, wellness, paid time off, 401(k) and profit-sharing plans. 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
• Low level of domestic U.S. travel required (up to 5% - 10% of time)
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
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
For highly qualified and experienced candidates, we are open to considering remote work arrangements for individuals who can travel as needed.
Qualifications
3 - 5 years of experience handling workers’ compensation claims
Experience with California 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
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 range: 75k-100k Benefits include: Health, dental, vision, life, disability, wellness, paid time off, 401(k) and profit-sharing plans. 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
• Low level of domestic U.S. travel required (up to 5% - 10% of time)