Senior Claims Examiner

About the role

Preferred Employers Insurance, A Berkley Company specializes in providing workers’ compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid-Larger Businesses and Group Association Members (Programs). The company’s distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company. Company URL: https://www.peiwc.com

Responsibilities

• Analyze and manage complex workers’ compensation claims.
• Review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims.
• Process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions.
• Act in a fiduciary role on behalf of policyholders, negotiate claim settlements and manage subrogation.
• Handle claims in utmost good faith in compliance with WCAB and State of California rules, regulations and statutes.
• Analyze and process workers’ compensation claims by investigating and gathering information to determine exposure.
• Negotiate settlement of claims up to designated authority level and make claims payments.
• Process complex or technically difficult claims.
• Calculate and assign timely and appropriate reserves to claims and manage reserve adequacy throughout the life of the claim.
• Calculate and pay benefits due; approve all claim payments; and settle claims within designated authority level.
• Develop and manage claims through well-developed action plans; continue to work the action plan to bring the claim to an appropriate and timely resolution.
• Prepare necessary state filings within statutory limits.
• Actively manage the litigation process; ensure timely and cost-effective claims resolution.
• Coordinate vendor referrals for additional investigation and/or litigation management.
• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
• Manage claim recoveries of all types, including subrogation, Second Injury Fund recoveries, and Social Security offsets.
• Report claims to the excess carrier; respond to requests for direction in a professional and timely manner.
• Frequently communicate with all appropriate parties involved with the claim.
• Refer cases as appropriate to management.
• Maintain professional client relationships.
• Actively execute appropriate claims activities to ensure consistent delivery of quality claims service.

Qualifications

• Bachelor’s degree preferred.
• 5+ years claims management experience.
• Professional certification as applicable to workers’ compensation required (WCCP preferred).
• In‑depth knowledge of appropriate insurance principles and laws for workers’ compensation.

Skills

• Strong written and verbal communication skills.
• Strong organizational skills.
• Strong negotiation skills.
• Strong analytical and interpretive skills.
• PC literate.

Benefits

• Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit‑Sharing plans.

Pay

Base Salary Range: $80,000 – $125,000 annually.