Senior Claims Representative
Berkley
Glen Allen, Virginia
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JOB DETAILS
SKILLS
ARM (Advanced RISC Machine), Adjudication, Analysis Skills, Business Portal, Claims Management, Claims Processing, Communication Skills, Conferences, Continuous Improvement, Customer Support/Service, Demographics, Detail Oriented, Expense Tracking, Healthcare Providers, Insurance, Interpersonal Skills, Litigation, Managed Care, Medical Treatment, Negotiation Skills, Organizational Skills, People Management, Presentation/Verbal Skills, Problem Solving Skills, Regulatory Compliance, Reinsurance, Reporting Skills, Staff Development, Staff Training, State Laws and Regulations, Subrogation, Team Lead/Manager, Time Management, Vendor/Supplier Evaluation, Vendor/Supplier Management, Willing to Travel, Worker's Compensation, Writing Skills
LOCATION
Glen Allen, Virginia
POSTED
7 days ago
BerkleyNet is an innovative workers compensation insurance provider that does all of our business online. Our Goal? To make doing business “Ridiculously Fast. Amazingly Easy.”
Responsibilities:
- 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 manage 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
- Serve as the team’s subject matter expert 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
- Notify management and develop reports for large exposure claims and comply 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
- Periodically travel to attend hearings, conferences and training sessions
- Attend and participate in claim file reviews with management and defense attorneys
- Coordinate and lead special projects or processes as assigned by management
- Assists with oversight and supervisory duties when the team supervisor is unavailable or as assigned by supervisor
- Support management with training and staff development
- Support management with vendor management activities
- Continuously strives to improve our product and business results through innovation
- Obtain and maintain adjuster license(s) in assigned jurisdictions
This role requires working onsite Monday through Thursday, with the option to work remotely on Fridays, in one of the following office locations: Manassas VA, Richmond VA, Irving TX or Scottsdale AZ.
Qualifications:
- 3 - 5 years of experience handling workers’ compensation claims
- 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
- AIC, ARM, CCP, or CPCU insurance designation preferred
About the Company
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