WC Sr. Claims Examiner

About the role

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

• Managing a caseload consisting of incoming and more complex workers’ compensation cases including extended disability cases, litigation, employer’s liability claims, and assigned claims.
• Handling all technical aspects of claim management for assigned files including compliance with all established performance guidelines.
• Investigating claims and making appropriate decisions regarding claim compensability and general claims management for assigned files.
• Documenting claim handling activities; creating and documenting action plans.
• Establishing appropriate case reserves.
• Actively managing medical treatment and disability while assisting the injured worker to return to work.
• Complying with all performance guidelines.
• Identifying loss trends and communicating to supervisor and/or clients.
• Using automated diary system to issue indemnity payments and for claims management.
• Investigating and managing claim subrogation and negotiating settlements.
• Managing coverage B or conflict of interest cases as assigned.
• Addressing customer complaints and inquiries in an exemplary and professional manner.
• Participating in client claim reviews when scheduled or requested.
• Performing other functions as assigned.

Qualifications

• Demonstrated working knowledge of workers’ compensation administration rules/laws.
• Excellent communication and presentation skills.
• Ability 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.

Benefits

The company offers a competitive compensation plan and robust benefits package for full time regular employees.

• Health
• Dental
• Vision
• Life
• Disability
• Wellness
• Paid time off
• 401(k)
• Profit-sharing plans

Pay

Salary Range: $90,000 - $100,000 (actual salary determined by scope, complexity, location, skills, education, training, credentials, experience, and other conditions of employment).

Requirements

• Occasional travel.