Workers Compensation Claims Examiner

Berkley•Irving, TX

1d•Hybrid

About The Position

Berkley Entertainment is seeking a Workers Compensation claims handler. This position is located in our Irving, TX headquarters on a hybrid basis. The position requires the ability to multitask, and candidates should have strong organizational and interpersonal communication abilities. The claims examiner reviews, evaluates and processes workers compensation medical only claims of moderate to severe complexity or severity in multiple jurisdictions. Responsible for the day to day management of moderate to severe complexity or severity medical only claims in multiple state jurisdictions. Investigates new claims to determine compensability and proactively follows up to determine the need for any Lost Time adjuster involvement. Is responsible for determining and satisfying jurisdictional reporting requirements. Ensure the claim is adequately reserved. Will review and pay medical and expense bills timely and accurately, and will evaluate each claim for subrogation potential. Act as a mentor to the Medical Only examiners, assisting in preparing them for the next step in career progression. Read and interpret surgical reports and notes. Occasionally review requests from surgeons for payments above the normal fee schedule.

Requirements

3+ years of prior Medical Only claims handling experience required.
Demonstrates strong written and verbal communication skills.
Ability to draft communications that are clear, concise, complete and professional.
Demonstrates strong time management and organizational skills.
Must have a TX Adjuster’s License.
Proficient in Microsoft Suite applications.
Working knowledge of Excel, Word, and general computer skills.

Nice To Haves

Bachelor’s degree in business, insurance or related field preferred.

Responsibilities

Reviews, evaluates and processes workers compensation medical only claims of moderate to severe complexity or severity in multiple jurisdictions.
Manages day-to-day operations of moderate to severe complexity or severity medical only claims in multiple state jurisdictions.
Investigates new claims to determine compensability.
Proactively follows up to determine the need for any Lost Time adjuster involvement.
Determines and satisfies jurisdictional reporting requirements.
Ensures claims are adequately reserved.
Reviews and pays medical and expense bills timely and accurately.
Evaluates each claim for subrogation potential.
Acts as a mentor to Medical Only examiners.
Reads and interprets surgical reports and notes.
Reviews requests from surgeons for payments above the normal fee schedule.