Berkley

  • Claims Trainee

    Location Name CA, Walnut Creek
    ID
    2019-2823
    Date Posted
    1 month ago(7/9/2019 5:20 PM)
    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

    The Claims Examiner Trainee, is the first working professional level of claims handling. Under close supervision, the Claims Examiner Trainee will receive in depth training of department objectives, and workers’ compensation laws to be able to administer basic claim benefits. The training will consist of learning to handle simple medical only claims to handling complex medical only claims, involving non-litigated, minimal lost time, soft tissue type injuries.  Other items handled include strain/sprain injuries due to repetitive motion and minor indemnity disability claims.  The Claims Examiner Trainee will ultimately be able to determine compensability and handle uncomplicated claims issues on assigned claims.  Claims handling activities will be performed in compliance with the rules, regulations and statutes of the WCAB and the State of California.

     

    Responsibilities include:  

    • Provide customer service – answer telephones by the third ring and re-direct callers as necessary to properly respond to customer inquiries.
    • Complete three-point contact to properly investigate assigned claims, evaluate coverage and determine compensability.
    • Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim.
    • Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
    • Negotiate outstanding liens on settled claims.
    • Complete assigned work via diaries and work queues in a timely manner.
    • Appropriately initiate QME and Voucher process for unrepresented claims.
    • Perform other duties as requested by manager.

    Key Accountabilities:

     

    • Investigation (Measured through the timeliness and quality of 3 point contacts and addressing of such issues as coverage, compensability, delay and/or denial of claim, subrogation, contribution, apportionment.)
    • Reserving (Measured through timely establishment and/or amendment of reserves using the philosophy of “most likely outcome.”)
    • File Management (Measured through the establishment, documentation, and execution of action plans.)
    • Medical Management (Measured through collaborative effort with the Medical Management Unit.)
    • Procedures (Measured through timely and accurate State filings, payment of bills, and appropriate coding.)

    Qualifications

    • 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

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