Workers Compensation - Claims Specialist

Company Details

 

W. R. Berkley Corporation, founded in 1967, is one of the nation’s premier commercial lines property casualty insurance providers. Founded in 2004, Berkley Environmental has underwriting and account executive units in seven regions. Berkley Environmental offers an array of coverages for virtually all classes traditionally known to have environmental liability exposures on both an admitted and non-admitted basis. We provide a comprehensive portfolio of commercial property casualty insurance, automobile liability and workers’ compensation, along with claim services, providing expertise to meet the unique business needs of our customers.

 

Responsibilities

Review, evaluate, negotiate and processes WC Claims of moderate/severe/catastrophic complexity, provide recommendations and strategies for resolution, and litigation management as appropriate. Collaborate with internal and external clients, and often interact with agents, claimants, and policyholders. Responsibilities

 

• Analyze and process workers’ compensation claims by investigating and gathering information to determine compensability and exposure on claims, handling multiple jurisdictions.
• Calculate and assign timely and appropriate reserves on claims and monitor reserve adequacy throughout the life of the claim.
• Develop and manage claims updating action plans as the claim progresses and bring the claim to an appropriate and timely resolution.
• Accurately calculate and timely pay benefits due pertaining to the jurisdictional guidelines.
• Operate within designated authority level and time constraints pertaining to payments and settlements.
• File appropriate forms per jurisdictional protocol, within statutory limits.
• Actively manage and guide the litigation process, ensuring timely and cost-effective claims resolution.
• Participate in claim reviews, which may require limited travel, and timely production of claim reports.
• Coordinate vendor referrals for additional investigation and/or litigation management.
• Use appropriate cost containment techniques including strategic vendor partnerships to mitigate overall cost of claims.
• Manage claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
• Frequently collaborate with all appropriate parties involved with the claim, and clearly document that collaboration.
• Maintain professional internal and external client relationships.
• Actively execute timely and appropriate claims activities to ensure consistent delivery of quality claims services.
• Proactively manage all litigated claims by clearly documenting the litigation plan and budget, retaining competent counsel, communicating with counsel on a regular basis and clearly documenting the litigation action plan and strategy.

Qualifications

• Work experience in the WC Claims arena of at least 7 -10 years of end to end claims handling MA, VA, PA, MD, DC, WV, CT, DE.
• Must have extensive understanding of WC Statutory benefits and state regulatory requirements in multiple jurisdictions, with the capacity to learn new jurisdictions as needed.
• Adjuster license required in area of adjusting specialty.
• The Company is an equal employment opportunity employer.
• Working knowledge of Excel, Word, and general computer skills.
• Extensive understanding of WC Statutory benefits and state regulatory requirements in multiple jurisdictions.
• Ability to learn new jurisdictions as needed.
• Claims investigation and compensability analysis.
• Reserve management and claim resolution planning.
• Litigation management and vendor coordination.
• Client relationship management and collaboration skills.

 

Education

• Bachelors degree preferred

Additional Company Details

We do not accept unsolicited resumes from third party recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees including: • Base Salary Range: $92k-135k • Eligible to participate in annual discretionary bonus • Benefits include: Health, dental, vision, dental, 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.

Responsibilities

Review, evaluate, negotiate and processes WC Claims of moderate/severe/catastrophic complexity, provide recommendations and strategies for resolution, and litigation management as appropriate. Collaborate with internal and external clients, and often interact with agents, claimants, and policyholders. Responsibilities
 
- Analyze and process workers’ compensation claims by investigating and gathering information to determine compensability and exposure on claims, handling multiple jurisdictions.
- Calculate and assign timely and appropriate reserves on claims and monitor reserve adequacy throughout the life of the claim.
- Develop and manage claims updating action plans as the claim progresses and bring the claim to an appropriate and timely resolution.
- Accurately calculate and timely pay benefits due pertaining to the jurisdictional guidelines.
- Operate within designated authority level and time constraints pertaining to payments and settlements.
- File appropriate forms per jurisdictional protocol, within statutory limits.
- Actively manage and guide the litigation process, ensuring timely and cost-effective claims resolution.
- Participate in claim reviews, which may require limited travel, and timely production of claim reports.
- Coordinate vendor referrals for additional investigation and/or litigation management.
- Use appropriate cost containment techniques including strategic vendor partnerships to mitigate overall cost of claims.
- Manage claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
- Frequently collaborate with all appropriate parties involved with the claim, and clearly document that collaboration.
- Maintain professional internal and external client relationships.
- Actively execute timely and appropriate claims activities to ensure consistent delivery of quality claims services.
- Proactively manage all litigated claims by clearly documenting the litigation plan and budget, retaining competent counsel, communicating with counsel on a regular basis and clearly documenting the litigation action plan and strategy.