Claims Representative

Company Details

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

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

Additional Company Details The Company is an equal employment opportunity employer. We do not accept any unsolicited resumes from external recruiting firms. 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: 65k - 95k 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)