Associate Claims Examiner

Berkley•San Diego, CA

4d•$60,000 - $80,000•Onsite

About The Position

Preferred Employers Insurance, A Berkley Company, a specialist in workers' compensation insurance for California businesses, is seeking an Associate Claims Examiner (ACE). This role supports the claims department by performing various administrative and customer service tasks. The ACE will be responsible for entering claim indemnity payments, filing SROI, issuing Benefit Notices, processing void/stop payment requests, and reissuing checks, all while aiming for a 99% timeliness goal. The position involves interacting with claims examiners, medical providers, and injured workers to assess return-to-work status and determine payment needs. The ACE acts in a fiduciary capacity, assessing the necessity of indemnity payments in compliance with California state regulations. This role is task-oriented, requires attention to detail, and involves routine, predefined job functions. The position includes 120 hours of classroom training within the first year to achieve Experienced Examiner Certification, with 30 hours of continuing education required every two years thereafter. Upon certification, additional duties may be assigned.

Requirements

2+ years of related administrative office work experience.
Strong written and verbal communication skills, attention to detail and deadline structures.
Ability to work both independently and collaboratively with all levels of staff.
Proficient with MS Office software and PC applications and systems.

Nice To Haves

Bachelor degree from an accredited college or university preferred
Knowledge of workers’ compensation principles and policies equivalent preferred.

Responsibilities

Make indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods.
Issue Benefit Notices as required with regards to the start, changing and ending of benefits.
Issue Permanent Disability denials in certain circumstances and notify claims examiner with an Activity.
Transmit Second Report of Information (SROI) to the State of California as required.
Gather and document information from medical providers on disability status of claimants.
Referral to Return to Work Coordinator who will gather and document information from insureds on return to work status of their injured employees as well as availability of modified or alternate duties. Follow up on return to work status, through coordinator, until an offer is made or a final decision not to accommodate is made.
Refers cases as appropriate to management by setting an activity for review.
Maintains professional client relationships.
Timely and appropriate notification to examiner on cases with indemnity payments, on need for appropriate reserves to ensure adequacy for life of claim.
Coordinate and process void, stop pay, and reissue Indemnity payments.
Offer and, if accepted, enroll claimants in our EFT program.
Attend Examiner Certification training as directed by Supervisor.
Upon certification as an Experienced Examiner, additional duties may be added including, but not limited to, drafting of settlement documents and calculation of wage statements.
Assist technical and operations with other duties as needed and as time allows.