Senior Claims Professional (Workers Compensation)

About the role

Berkshire Hathaway Homestate Companies, Workers Compensation Division, seeks a Senior Claims Professional to join their team.

Responsibilities

• Aids injured workers achieving rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support.
• Effectively communicates with injured workers and employers.
• Demonstrates expertise and empathy, building trust and moving the claim forward, including timely three-point contacts on all new losses.
• Manages claims with an outcome-based and resolution focus.
• Demonstrates effective strategic plans for future handling that are well outlined in plans of action and followed through in a timely fashion.
• Demonstrates effective decision-making in compensability determinations and benefit authorizations (within designated authority parameters).
• Proactively utilizes resources such as Medical Management, SIU, Subrogation, Recovery, and Legal to ensure accurate determinations in compensability, causal relationship, appropriate medical treatment, and to achieve favorable outcomes.
• Prepares and maintains timely, accurate reserves on all claims for expected future costs of medical treatment, benefits, and other elements in accordance with Claims Handling Guidelines.
• Ensures reserves are escalated and approved as appropriate.
• Ensures there is appropriate reserve documentation in the file.
• Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
• Reduces fraud through early identification and escalation.
• Effectively manages defense attorneys.
• Demonstrates excellence in litigation management by being prepared for hearings in a timely manner and appropriately considering exposures, settlement options, and other legal issues.
• Reviews and approves vocational rehabilitation plans.
• Effectively manages vendors and providers. Identifies need for assignment and removal of vendors and makes effective use of vendor expertise while maintaining ownership of the claim.
• Demonstrates expertise in technical aspects of claim management. Works with Medicare Set-Asides, Structured Settlements, and/or Part B issues.
• Maintains effective relationships with internal and external service partners, including participation in periodic telephonic claims reviews.
• Calculates and pays benefits in accordance with the law. Ensures that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings.
• Ensures continual education requirements are met.

Requirements

• A minimum of five (5) years of indemnity adjusting experience managing large and/or complex workers' compensation claims and accounts required.
• Licensed to adjust workers’ compensation claims in one or more jurisdictions.
• Proficient in Microsoft Office Suite applications and able to be proficient on applicable databases, Claims systems, and vendor software programs.

Qualifications

• Education: High School Diploma or equivalent certificate required; Bachelor's degree from a four-year college or university preferred.

Skills

• Self-starter who can work under minimum direction, achieve defined results, and accept ownership of their work product.

Benefits

• Manageable caseload with in-house Medical Management support (UR, Med Bill Review, Resource Nurses)
• Work-Life Balance
• Work From Home Program (up to 2 days per week)
• Office Within Walking Distance of The Old Market
• Free On-Site Fitness Facility
• Garage Parking
• Benefits:
• Paid Time Off
• Paid Holidays
• Retirements Savings Match
• Group Health Insurance (Medical, Dental, and Vision)
• Life and AD&D Insurance
• Long Term Disability Insurance
• Accident and Critical Illness Insurance
• Flexible Savings Accounts
• Employee Assistance Program
• Tuition Reimbursement Program
• Employee Referral Program
• Diversity, Equity and Inclusion Program

Pay

Details about pay are not specified in this posting.

Schedule

Details about the schedule are not specified in this posting.