WC Sr. Claims Examiner

Company Details

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

Responsible for managing a caseload consisting of incoming and more complex workers' compensation cases including extended disability cases, litigation, employer's liability claims, and assigned claims. Responsible for all technical aspects of claim management for assigned files including compliance with all established performance guidelines.

 

Responsibilities

• Investigate claims and make appropriate decisions regarding claim compensability and general claims management for assigned files.
• Document claim handling activities; create and document action plans.
• Establish appropriate case reserves.
• Actively manage medical treatment and disability while assisting the injured worker to return to work.
• Comply with all performance guidelines.
• Identify loss trends and communicate to supervisor and/or clients.
• Use automated diary system to issue indemnity payments and for claims management.
• Investigate and manage claim subrogation and negotiate settlements.
• Manage coverage B or conflict of interest cases as assigned.
• Address customer complaints and inquiries in an exemplary and professional manner.
• Participate in client claim reviews when scheduled or requested.
• May perform other functions as assigned.

 

Qualifications

• Demonstrated working knowledge of workers' compensation administration rules/laws.
• Must be able to interface with clients, legal counsel, health care professionals, etc.
• Travel: Occasional travel.
• While performing the duties of this job, the employee is regularly required to be seated for sustained periods of time; be able to pick up, pinch, twist, or keyboard; must be able to communicate detailed or important information accurately; distinguish sounds at normal levels (with or without correction) and be able to receive detailed information orally.
• The employee is occasionally required to move about the office to accomplish tasks; ability to reach in any direction; raise or lower objects or move objects from place to place; and hold onto objects.
• Occasionally, the employee may need to move or exert force up to 10 pounds.
• The employee is regularly required to operate a computer and other office equipment (phone, copier and printer)

• Excellent communication and presentation skills.

• 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.

• Communication

• Customer Focus and Teamwork

• Flexibility

• Delivers Results

• Technical & Job Excellence

• Accountability

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.

Additional Company Details

Important Outside Agency Notice: Only solicited resumes/candidate profiles that are submitted by a Berkley Preferred Agency Partner that have been requested by Berkley Internal Recruiting to engage in a particular search will be subject to the payment of Agency fees as defined in the formal agency agreement. Any unsolicited resumes/candidate profiles are not subject to payment of the agency fees. The company offers a competitive compensation plan and robust benefits package for full time regular employees. Base salary & Benefits include Health, dental, vision, life, disability, wellness, paid time off, 401(k) and profit-sharing plans. Salary Range: $80,000 - $110,000 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.