Senior Claims Specialist

Berkley•Homewood, AL

About The Position

This position is responsible for managing both lost time and med only claims across multiple jurisdictions up to $250,000 in exposure. This includes investigation, evaluation, and resolution of claims. Interface with underwriting, risk management, case management, clients, and vendors as appropriate in controlling costs and loss ratios and providing the claimant with appropriate care. Provide leadership within the claims department. Key functions include but are not limited to the following: Oversee catastrophic and large loss claims from beginning to resolution. Manage all technical aspects of claims including coverage, disability benefit management, medical management, file management, litigation management, subrogation, reserving and settlement. Verify and interpret coverage issues. Consult with attorneys, assist in negotiation of settlement, mediations and trials (attend trials as necessary). Resolve problems involving multi-faceted claims handling. Investigate, evaluate, and negotiate claims toward resolution and provide medical needs within jurisdictional guidelines and Berkley Industrial Comp philosophies. Determinate appropriate reserves to adequately reflect exposure of losses. Attend and participate in training sessions to the accounts or account visits and claim reviews.

Requirements

Bachelor’s degree with concentration in criminal justice, public administration, business, nursing or insurance OR equivalent work experience.
Five (5) years’ minimum of experience adjusting workers’ compensation claims with significant experience handling Workers’ Compensation claims.
Possess and maintain a professional adjusting license in all jurisdictions applicable or obtained within one year of job acceptance.
Strong interpersonal, analytical, and negotiation skills.

Nice To Haves

Experience across multiple jurisdictions preferred.
Ten (10) years’ experience preferred.

Responsibilities

Oversee catastrophic and large loss claims from beginning to resolution.
Manage all technical aspects of claims including coverage, disability benefit management, medical management, file management, litigation management, subrogation, reserving and settlement.
Verify and interpret coverage issues.
Consult with attorneys, assist in negotiation of settlement, mediations and trials (attend trials as necessary).
Resolve problems involving multi-faceted claims handling.
Investigate, evaluate, and negotiate claims toward resolution and provide medical needs within jurisdictional guidelines and Berkley Industrial Comp philosophies.
Determinate appropriate reserves to adequately reflect exposure of losses.
Attend and participate in training sessions to the accounts or account visits and claim reviews.