Sr. Workers Compensation Claims Representative - CA, NV, AZ

Berkley • Riverton, UT

266d • $65,000 - $95,000 • Onsite

About The Position

As a Claims Representative at BerkleyNet, you will be responsible for the investigation, evaluation, mitigation, and resolution of medical only and lost time workers' compensation claims of moderate complexity in multiple jurisdictions. Your role will involve interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due. You will also calculate and set timely financial reserves, manage reserve adequacy throughout the claim lifecycle, and record and code injured worker demographics, job information, and accident information in the company's claims management system. Additionally, you will issue timely payments to injured workers, medical providers, and service vendors, coordinate medical treatment for injured workers, and negotiate settlements of claims within designated authority. You will need to demonstrate a working knowledge of the Workers' Compensation Act and manage subrogation and joint coverage recovery opportunities. Regular communication with policyholders and other parties is essential, as is the ability to manage the claims litigation process effectively. You will also participate in special projects and may need to travel periodically for hearings and training sessions.

Requirements

• Excellent written and verbal communication skills.
• Strong interpersonal and relationship building skills.
• Exceptional time management and organization skills.
• Strong analytical and critical thinking skills.
• Ability to work independently and strategically problem solve.
• Ability to diplomatically manage conflict.
• Ability to develop relationships within the organization and work effectively across departments.
• Strong discretion and integrity in dealing with highly confidential and sensitive information.
• Detail oriented.
• Bachelor's degree or equivalent insurance industry work experience.

Nice To Haves

• Experience with CA, AZ & NZ claims.

Responsibilities

• Investigate workers' compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due.
• Calculate and set timely financial reserves and proactively manage reserve adequacy throughout the claim lifecycle.
• Record and code injured worker demographics, job information, and accident information in the company's claims management system and file necessary forms with state regulatory agencies.
• Issue timely payments to injured workers, medical providers, and service vendors.
• Coordinate and actively manage medical treatment of injured workers to ensure timely rehabilitation.
• Negotiate settlements of claims within designated authority with injured workers and attorneys.
• Demonstrate a working knowledge of the Workers' Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions.
• Identify and manage subrogation, Second Injury Fund, and joint coverage recovery opportunities.
• Regularly communicate claim activity and status updates to policyholders, injured workers, and other interested parties in a professional manner.
• Respond in a timely manner to communications from policyholders, injured workers, and other interested parties.
• Notify management and develop reports for large exposure claims and comply with reinsurance reporting requirements.
• Manage the claims litigation process to ensure timely and cost-effective claims resolution.
• Monitor the expenses and effectiveness of managed care and investigation vendors.
• Actively participate in special projects as assigned by management.
• Periodically travel to attend hearings, conferences, and training sessions.
• Attend and participate in claim file reviews with management and defense attorneys.
• Continuously strive to improve product and business results through innovation.
• Obtain and maintain adjuster licenses in assigned jurisdictions where required.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• Disability insurance
• Wellness programs
• Paid time off
• 401(k)
• Profit-sharing plans

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Administrative and Support Services
• Education Level: Bachelor's degree