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biBerk Business Insurance · 1 day ago

Complex Claims Specialist - Workers' Compensation (Western USA)

United States

Full-time

Remote

Senior Level, Lead/Staff

$100K/yr - $125K/yr

10+ years exp

biBerk Business Insurance is part of Berkshire Hathaway Direct Insurance Company, focusing on commercial small business insurance products. They are seeking an experienced Complex Claims Specialist to manage a caseload of complex Workers' Compensation claims, ensuring compliance with regulations and providing exceptional customer service.

Auto InsuranceCommercial InsuranceInsuranceProperty Insurance

Responsibilities

Investigate coverage, determine compensability, and manage a pending of high exposure Workers’ Compensation claims involving catastrophic injuries and complex cases

Proactively establish and update reserves throughout the life of the claim to reflect claim exposure and document supporting rationale

Resolve claims within authority and make independent case value recommendations to senior leadership on cases which exceed authority

Participate in reserving, pricing and strategy discussions with senior leadership

Collaborate with outside defense counsel to effectively manage litigated files according to established litigation management guidelines

Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills

Ensure compliance with state and federal Workers’ Compensation regulations

Provide exceptional customer service to policyholders, agents, injured workers, medical providers, legal, and vendors

Follow escalation and reporting requirements on claims with significant exposure

Develop creative resolution strategies to manage losses involving complex issues, effectively utilizing appropriate internal and external resources

Document claim files in accordance with company and regulatory guidelines

Identify subrogation potential and red flags that require SIU involvement

Train new team members

Act as a technical resource to less experienced claims representatives

Maintain continuing education requirements

Qualification

Active adjuster licenseSIP certificationWorkers’ compensation expertiseStructured settlementsMedicare Set-AsidesMS Word proficiencyExcel proficiencyLeadership skillsCommunication skillsTime management skillsNegotiation skillsAttention to detail

Required

Active adjuster license required

SIP certification required

10+ years of experience handling complex workers' compensation claims

Excellent organizational, leadership, communication and time management skills

Experience with structured settlements and Medicare Set-Asides

Ability to work in a fast-paced, collaborative, virtual office environment

Strong analytical, organizational, and time management skills

Excellent written and verbal communication skills

Ability to work independently and meet assigned deadlines

Strong negotiation skills

Ability to multi-task and effectively prioritize tasks with frequent interruptions

Proficiency with MS Word, Excel and internet applications

Highly attentive to details

Able to work under pressure and execute good judgment in sensitive situations

Advanced verbal and written communication skills are essential for interacting with internal and external stakeholders

BA/BS degree required

Preferred

Multi-state experience handling Workers' Compensation claims in the following jurisdictions is preferred: California, Arizona, Colorado, Wyoming, Texas, Oklahoma

AIC, SCLA, CPCU or other industry designation a plus