Berkley

  • Claims Examiner/Adjuster

    Location Name CA, Walnut Creek
    ID
    2018-1932
    Date Posted
    4 months ago(9/27/2018 9:15 AM)
    Company
    Preferred Employers Insurance
    Primary Location
    US-CA-Walnut Creek
    Category
    Claims
  • Company Details

    Preferred Employers Insurance_Logo

     

    Preferred Employers Insurance Company began operations in San Diego, California in 1998. The company provides workers’ compensation insurance for a wide variety of industries. Our goal is to provide our customers with a stable and reliable workers’ compensation insurance product regardless of market cycles. We are dedicated to being the preferred workers’ compensation insurance solution for California businesses.

    Responsibilities

    Join our team of highly skilled Claims Examiners responsible for the analysis and management of workers’ compensation claims.  Our Claims Examiners review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims; as well as process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions.   In this position you will act in a fiduciary role on behalf of policyholders, negotiate claim settlements and manage subrogation.

     

    Our Claims Examiners conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. We function with a high degree of competency and sound judgment, coupled with consistent results!

     

    Responsibilities for this opportunity include:

     

    • Analyzing and processing workers’ compensation claims by investigating and gathering information to determine the exposure on the claim.
    • Negotiating the settlement of claims up to designated authority level and making claims payments.
    • Calculating and assigning timely and appropriate reserves to claims and continuing to manage reserve adequacy throughout the life of the claim.
    • Calculating and paying benefits due; approving all claim payments; and settling claims within designated authority level.
    • Developing and managing claims through well-developed action plans; continuing to work the action plan to bring the claim to an appropriate and timely resolution.
    • Preparing necessary state filings within statutory limits.
    • Actively managing the litigation process; ensuring timely and cost effective claims resolution.
    • Coordinating vendor referrals for additional investigation and/or litigation management.
    • Using appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
    • Managing claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
    • Reporting claims to the excess carrier, responds to requests of directions in a professional and timely manner.
    • Frequently communicating with all appropriate parties involved with the claim.
    • Referring cases as appropriate to management.
    • Maintaining professional client relationships.
    • Actively executing appropriate claims activities to ensure consistent delivery of quality claims service.

    Qualifications

    Our ideal candidate will have the following:

     

    • 1+ years claims management experience in workers’ compensation
    • Knowledge of appropriate insurance principles and laws for workers’ compensation
    • Strong written and verbal communication skills
    • Strong organizational skills
    • Strong negotiation skills
    • Strong analytical and interpretive skills
    • PC literate
    • Baccalaureate degree from an accredited college or university preferred
    • Professional certification as applicable to workers’ compensation required

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