WC 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:

To perform workers' compensation claims adjudication and investigation. Responsible for all technical aspects of claim management for assigned including compliance with all established performance guidelines.

• Properly investigate and handle all types of workers' compensation files including lost time, litigation and long-term exposure within predetermined claim-handling guidelines.
• Initiate return-to-work discussions with the employer and effect return-to-work for the injured worker.
• Establish timely and appropriate case reserves.
• Investigate and manage subrogation and negotiate settlements.
• Use automated diary system to issue indemnity benefits and provide claim management.
• Accurately calculate and pay wage loss and other benefits.
• Assign rehabilitation and monitor costs and outcomes.
• Document all action plans and evaluations for claim resolution.
• Maintain organized electronic files.
• Interact with clients to establish/improve communication and service capabilities.
• Interact and communicate with state agencies, attorneys and other providers.
• Address customer complaints and inquiries in an exemplary and professional manner.
• Achieve specific performance outcomes related to quality and quantity of work as established by management.
• Provide cost containment for individual claim and overall claim costs for account to achieve account profitability.
• Define medical and rehabilitation payment parameters staff.
• May perform other functions as assigned.

Qualifications:

• 1 - 2 years minimum workers' compensation claim processing experience.
• Experience must include handling of medical-only, lost-time and litigated claims.
• Demonstrated working knowledge of workers' compensation administration rules/laws.

• Good to excellent math and analytical ability.

• Good to excellent oral and written communication skills.

• Excellent customer service skills.

Education

• College degree or relevant experience.

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: $60k-$80k 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.