Claims Specialist

Company Details

 

BerkleyNet is an innovative workers compensation insurance provider that does all our business online. Our Goal? To make doing business “Ridiculously Fast. Amazingly Easy.”

Responsibilities

As a Claims Specialist, you will be responsible for handling high exposure and complex workers’ compensation claims. You will serve as a Subject Matter Expert (SME) for all technical claims handling activities, including regulatory compliance, serve as the primary liaison for key internal and external business partnerships and programs, lead special projects, and lead claims related account management activities for large clients.

 

• Effectively investigate, evaluate, mitigate, and resolve a pending inventory of litigated and high exposure workers’ compensation claims within delegated authority and in accordance with performance standards
• Notify claims management of high-exposure claims and assist in compliance with reinsurance reporting requirements
• Serve as the Subject Matter Expert (SME) for all technical aspects of claims handling including coverage, disability management, medical management, file management, litigation management, subrogation, reserving and settlement in multiple jurisdictions
• Assume full responsibility of claims-related account management activities for our large clients
• Collaborate closely with Business Development and Underwriting teams to deliver and maintain high-level service
• Identify and notify management of any unfavorable trends related to account management
• Serve as primary liaison with key internal and external business partners and vendors and actively work to develop maintain and improve the partnerships
• Assist senior claims management with screening and appointing new defense firms
• Coordinates and actively facilitates litigation file reviews with defense firms, adjusters and claims management to develop strategic action plans in accordance with our claims handling standards
• Schedules, prepares, and facilitates settlement conferences with defense and plaintiff firms to effectuate settlements
• Maintain and demonstrate high-level of knowledge of the Workers Compensation Act and Rules and Regulations in multiple jurisdictions
• Actively participate in the training and development of claims adjusters through mentoring and conducting training for new hires and existing staff
• Identify and addresses areas for coaching and training needs of claims adjusters and communicates needs with claims management and assists in development of action plans for improvement
• Coordinate relevant legal training seminars for claims staff in assigned jurisdictions
• Visibly supports the overall claims adjusting and managed care functions in multiple jurisdictions
• Assist claims management in monitoring and researching jurisdictional case law and statutory legal trends
• Demonstrate the use of tact and discretion in all communications and provides a positive contribution to the morale of the claims department
• Lead special projects as assigned by senior claims management
• Continuously strives to improve our product and business results through innovation
• Obtain and maintain adjuster license in multiple jurisdictions as required

 

Qualifications

• Minimum of 5-7 years of technical claims handling experience with a heavy emphasis on workers’ compensation claims in multiple jurisdictions
• Supervisory experience a plus, but not required
• Consistently display a high-level of ownership, drive, and accountability
• Acts as an informal leader
• Excellent written, verbal, interpersonal and relationship building skills
• Exceptional time management and organization skills
• Strong insurance business acumen and leadership skills
• Ability to work independently and strategically problem solve
• Strong analytical and critical thinking skills
• 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
• Display a high degree of attention to detail

Additional Company Details

We do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Additional Requirements

• Low to moderate level of travel (up to 10% - 15% of time) • Ability to travel nationally to attend legal hearings, conferences, trainings, file reviews, audits, and business partner meetings

Sponsorship Details

Sponsorship not Offered for this Role