WC Sr. Claims Examiner

Berkley•Saint Paul, MN

2d•$65,000 - $85,000•Onsite

About The Position

This position is responsible for managing a caseload of incoming and more complex workers' compensation cases, including extended disability cases, litigation, employer's liability claims, and assigned claims. The role involves all technical aspects of claim management, ensuring compliance with established performance guidelines. The Claims Examiner will investigate claims, make decisions on compensability, establish reserves, and actively manage medical treatment and disability to facilitate the injured worker's return to work. Additionally, the role requires identifying and communicating loss trends, managing subrogation, negotiating settlements, handling coverage B or conflict of interest cases, addressing customer inquiries, and participating in client claim reviews. The company is a member of W. R. Berkley Corporation, a Fortune 500 holding company, and Berkley Risk focuses on providing program administration services and insurance operations for self-insured entities.

Requirements

Demonstrated working knowledge of workers’ compensation administration rules/laws.
Excellent communication and presentation skills.
Must be able to interface with clients, legal counsel, health care professionals, etc.
Good math and analytical ability.
Excellent customer service skills.
Basic PC skills and a working knowledge of Windows environment.
Experience with a client/server based claims processing system.

Nice To Haves

Occasional travel

Responsibilities

Managing a caseload of incoming and more complex workers' compensation cases, including extended disability cases, litigation, employer’s liability claims, and assigned claims.
Performing all technical aspects of claim management for assigned files, including compliance with all established performance guidelines.
Investigating claims and making appropriate decisions regarding claim compensability and general claims management for assigned files.
Documenting claim handling activities and creating and documenting action plans.
Establishing appropriate case reserves.
Actively managing medical treatment and disability while assisting the injured worker to return to work.
Complying with all performance guidelines.
Identifying loss trends and communicating them to the supervisor and/or clients.
Using an automated diary system to issue indemnity payments and for claims management.
Investigating and managing claim subrogation and negotiating settlements.
Managing coverage B or conflict of interest cases as assigned.
Addressing customer complaints and inquiries in an exemplary and professional manner.
Participating in client claim reviews when scheduled or requested.
Performing other functions as assigned.