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Preferred Employers Insurance (a Berkley Company) · 21 hours ago

Sr. Claims Examiner

Walnut Creek, CA

Full-time

Onsite

Senior Level

$100K/yr - $116K/yr

5+ years exp

Preferred Employers Insurance, A Berkley Company specializes in providing workers’ compensation insurance to California business owners. The Senior Claims Examiner is responsible for analyzing and managing complex workers’ compensation claims, negotiating settlements, and ensuring compliance with industry standards and regulations.

Financial ServicesHealth InsuranceInsurance

No H1B

Hiring Manager

Azaelia Garcia

Responsibilities

Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure on the claim

Negotiates settlement of claims up to designated authority level and makes claims payments

Processes complex or technically difficult claims

Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim

Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level

Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution

Prepares necessary state filings within statutory limits

Actively manages the litigation process; ensures timely and cost-effective claims resolution

Coordinates vendor referrals for additional investigation and/or litigation management

Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims

Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets

Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner

Frequently communicates with all appropriate parties involved with the claim

Refers cases as appropriate to management

Maintains professional client relationships

Actively executes appropriate claims activities to ensure consistent delivery of quality claims service

Qualification

Claims management experienceWorkers' compensation certificationInsurance principles knowledgeAnalytical skillsNegotiation skillsPC literateWritten communication skillsVerbal communication skillsOrganizational skills