Claims Representative
BerkleyNet (a Berkley Company), Irving, TX, United States
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 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 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 of claims within designated authority with injured workers and attorneys
Demonstrate a working knowledge 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
Respond in a timely manner to communications from policyholders, injured workers, and other interested parties
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
Actively participate in special projects as assigned by management
Periodically travel to attend hearings, conferences and training sessions
Attend and participate in claim file reviews with management and defense attorneys
Continuously strive to improve our product and business results through innovation
Obtain and maintain adjuster licenses in assigned jurisdictions where required
Remote work Friday alternative to onsite Monday-Thursday in one of the following office locations: Manassas VA, Richmond VA, Irving TX or Scottsdale AZ.
Qualifications
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
Bachelor’s degree or equivalent insurance industry work 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.
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)
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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 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 of claims within designated authority with injured workers and attorneys
Demonstrate a working knowledge 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
Respond in a timely manner to communications from policyholders, injured workers, and other interested parties
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
Actively participate in special projects as assigned by management
Periodically travel to attend hearings, conferences and training sessions
Attend and participate in claim file reviews with management and defense attorneys
Continuously strive to improve our product and business results through innovation
Obtain and maintain adjuster licenses in assigned jurisdictions where required
Remote work Friday alternative to onsite Monday-Thursday in one of the following office locations: Manassas VA, Richmond VA, Irving TX or Scottsdale AZ.
Qualifications
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
Bachelor’s degree or equivalent insurance industry work 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.
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)
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