WC Sr. Claims Examiner

Berkley•Saint Paul, MN

About The Position

The WC Sr. Claims Examiner manages a caseload of incoming and complex workers’ compensation claims, including extended disability, litigation, employer’s liability, and assigned claims. The role is responsible for the technical aspects of assigned claim files and for complying with established performance guidelines. The examiner investigates claims, makes compensability and claims-management decisions, manages medical treatment and disability, and supports injured workers’ return to work. The role also involves setting reserves, managing subrogation and settlements, addressing customer inquiries, and participating in client claim reviews. Occasional travel is required. The position requires a BA/BS degree and three years of experience, including litigation, subrogation, and complex medical/legal issues; alternatively, two years of post-high-school education and five years of workers’ compensation claims-management experience. The company describes itself as a member company of W. R. Berkley Corporation, an A. M. Best A+ rated Fortune 500 holding company. Berkley Risk provides program administration services and insurance operations for self-insured entities.

Requirements

Demonstrated working knowledge of workers’ compensation administration rules and laws.
Ability to interface with clients, legal counsel, health care professionals, and others.
Excellent communication and presentation skills.
Good math and analytical ability.
Excellent customer service skills.
Basic PC skills and working knowledge of the Windows environment.
Experience with a client/server-based claims processing system.
BA/BS degree and three years of experience, including litigation, subrogation, and complex medical/legal issues; alternatively, two years of post-high-school education and five years of experience in workers’ compensation claims management.
Ability to meet the role’s physical requirements, including sustained sitting, keyboarding and operating office equipment, communicating and receiving detailed information, and occasional movement or handling of objects up to 10 pounds.

Responsibilities

Manage a caseload of incoming and more complex workers’ compensation cases, including extended disability, litigation, employer’s liability, and assigned claims.
Manage all technical aspects of assigned claim files and comply with established performance guidelines.
Investigate claims and make appropriate decisions regarding compensability and general claims management.
Document claim-handling activities and create and document action plans.
Establish appropriate case reserves.
Actively manage medical treatment and disability while assisting injured workers in returning to work.
Identify loss trends and communicate them to a supervisor and/or clients.
Use an automated diary system to issue indemnity payments and manage claims.
Investigate and manage claim subrogation and negotiate settlements.
Manage coverage B or conflict-of-interest cases as assigned.
Address customer complaints and inquiries professionally.
Participate in client claim reviews when scheduled or requested.
Perform other functions as assigned.