Sr Claims Examiner
Sr Claims Examiner
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Job Description
Company Details
W. R. Berkley Corporation founded in 1967 is one of the nations 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 nonadmitted 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.
Company URL: company is an equal opportunity employer.
Responsibilities
Under limited supervision review evaluate negotiate and processes WC Claims of moderate/severe/catastrophic complexity provide recommendations and strategies for resolution and litigation management as appropriate according to Best Practices. Collaborate with internal and external clients and often interact with agents claimants and policyholders. National licensing for each state that requires license including CA and VT.
Seeking a Sr. WC Specialist for the Eastern Seaboard Jurisdictions with preferred savvy in MA RI CT NH VT and knowledge of ME NJ PA NY FL GA NC SC and other jurisdictions or willingness to train to handle other jurisdictions.
The position will be physically located in either our Jersey City NJ or our Irving TX Offices. We will consider remote work based on expertise and geographical location.
Duties and Responsibilities:
- Analyze and process workers compensation claims by investigating and gathering information to determine compensability and exposure on claims handling all national lost time claims.
- 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 resolutions based on specific jurisdictional protocol and guidelines.
- Timely file appropriate forms per jurisdictional protocol within statutory limits and per EDI requirements.
- Participate in claim reviews which may require limited travel and timely production of claim reports.
- Coordinate vendor referrals for nurse case management and occasional investigations.
- 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/diaries to ensure consistent delivery of quality claims services.
Key functions include but are not limited to the following:
- Work experience in the WC Claims arena of at least 5 years end to end claims handling.
- Understanding of WC Statutory benefits and state regulatory requirements in multiple jurisdictions with the capacity to learn new jurisdictions as needed.
- Working knowledge of Excel Word and general computer skills.
- Adjuster license required in area of adjusting specialty. Ideal candidate will work from the Jersey City or Irving office on a hybrid schedule. There is potential for full time work from home opportunity for a candidate given their geographic location and experience.
Qualifications
- Demonstrates strong written and oral communications skills.
- Ability to draft communications that are clear concise complete and professional.
- Negotiation skills mandatory and ability to interact with all levels of the organization.
- Demonstrates organizational skills while working on multiple projects diaries or activities.
Additional Company Details
The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include:
Base Salary Range: $
Eligible to participate in annual discretionary bonus.
Benefits: Health Dental Vision Life Disability Wellness Paid Time Off 401(k) and ProfitSharing 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.
Sponsorship Details
Required Experience:
Senior IC
Employment Type
Unclear
