WC Claims Representative 1

Berkley•Minneapolis, MN

10d•$50,000 - $62,000•Onsite

About The Position

We’re a member company of W. R. Berkley Corporation, an A. M. Best A+ rated Fortune 500 holding company. Berkley is comprised of individual operating units that serve a defined insurance market segment. Berkley Risk is focused on providing self-insured entities program administration services and insurance operations which can include taking or sharing risk using Berkley paper. This capability allows us to customize both an insurance company option and a purely administrative option for our customers.

Requirements

Minimum of two years office experience or post-high school education.
Ability to interpret and evaluate limited medical and limited legal concepts.
Analysis and decision-making skills.
Good to excellent math and analytical ability.
Good oral and written communication skills.
Willing to learn and apply negotiation techniques.

Responsibilities

Investigate claims for compensability by analyzing claims-related information and applying claim handling guidelines.
Verify active policy/coverage on new claims and determine if claim involves medical benefits only or includes exposure for lost time.
Establish case reserves consistent with exposure on new claims. Examine reserves on a regular basis and adjust reserves if there is a significant change in exposure.
Serve and file state forms when required.
Investigate subrogation issues on claims, and place responsible third parties on notice of our client’s subrogation interest. Pursue subrogation or transfer file as appropriate.
Receive and respond to telephone inquiries. This includes but is not limited to contact with injured employees, employers and health care providers.
Authorize payment of bills for reasonable and necessary medical treatment, expenses associated with claims investigations and obtaining records. Send bills and records for audit when appropriate.
Authorize or deny medical benefits within established time frames.
Manage caseload with assistance of computer-operated diary and maintain current diaries.
Participate in on-going training opportunities to remain current on all aspects of claims handling and customer service.
Ensure timely filing of regulatory documents via EDI (Electronic Data Interchange); submit applicable claims to Index Bureau Reporting (ISO) and document files as applicable.
Provide additional levels of management and claim department operational support to include payment review/approval/input and complete scheduled or special project work as needed.
May perform other functions as assigned