Claims Examiner Trainee (Spanish Fluency Preferred)

Berkshire Hathaway Homestate Companies•Sacramento, CA

15d•Onsite

About The Position

Upon successful completion of the Claims Training program, the Claims Adjuster Trainee will be responsible for management of a caseload of workers compensation claims from inception to resolution. Responsibilities include initial investigation and analysis, strategic planning, management of medical care and legal process, and client relations. This individual will continue to build on claims knowledge and claims will increase in number and complexity.

Requirements

Minimum of High School Diploma or equivalent certificate required; Bachelorâ€™s degree from four-year college or university is preferred.
Ability to communicate effectively verbally and in writing; Spanish Fluency ability a plus.
Solid interpersonal and customer service skills.
Ability to manage and prioritize multiple assignments in a fast-paced environment.
Strong organization skills to ensure tasks are completed within hard deadlines.
Proficient in the Microsoft Office Suite of applications and be proficient, or able to become proficient, on applicable databases, systems, and vendor software programs.

Nice To Haves

Spanish Fluency ability a plus.

Responsibilities

Successfully completes classroom training introducing workers compensation claims handling strategies, medical terminology, statutory requirements, and investigative skills.
Conducts initial investigation of reported claims to determine coverage, compensability, severity, and gather all other relevant information via three-point contact telephone calls.
Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
Develops and updates a Plan of Action for the successful resolution of each claim.
Makes prompt, sound decisions on issues that arise based on the best information available, ensuring that work is performed in accordance with Company guidelines and applicable statutory requirements. Timely escalates issues/red flags to Supervisor.
Ensures benefits due injured worker are calculated and issued appropriately in accordance with legal requirements including the issuance of appropriate notices and filings.
Fosters a positive and close working relationship with internal and external partners, including Call Center, Medical Management, Special Investigations, and Indemnity Adjusting Staff.