Claims Representative

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

As a Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of medical only and lost time workers’ compensation claims of moderate complexity in multiple jurisdictions.

• 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 manages 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
• 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 develops reports for large exposure claims and complies 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 participates in claim file reviews with management and defense attorneys
• Continuously strives to improve our product and business results through innovation
• Obtain and maintain adjuster licenses in assigned jurisdictions where required

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

• Bachelors’ 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 agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. - Base Salary Range: $65k-$75k 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)

Sponsorship Details

Sponsorship not Offered for this Role

Responsibilities

As a Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of medical only and lost time workers’ compensation claims of moderate complexity in multiple jurisdictions.
- 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 manages 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
- 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 develops reports for large exposure claims and complies 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 participates in claim file reviews with management and defense attorneys
- Continuously strives to improve our product and business results through innovation
- Obtain and maintain adjuster licenses in assigned jurisdictions where required