Sr. Claims Representative California Workers' Compensation

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.

• 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 companys 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 teams 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

For highly qualified and experienced candidates we are open to considering remote work arrangements for individuals who can travel as needed.

• 3 - 5 years of experience handling workers compensation claims
• Experience with California 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