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

As a Senior Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of an inventory of lost time and catastrophic workers’ compensation injury claims in California and other jurisdictions.

• Investigate workers’ compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits due
• Calculate and set timely financial reserves and proactively manage reserve adequacy throughout claim lifecycle
• Record and code injured worker demographics, job information and accident information in company’s claims management system and files necessary forms with state regulatory agencies
• Issue timely payments to injured workers, medical providers and service vendors
• Coordinate and actively manage medical treatment of injured workers to ensure timely rehabilitation
• Negotiate settlements of claims within designated authority with injured workers and attorneys
• Serve as the team’s subject matter expert of the Workers’ Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictions
• Identify and manage subrogation, Second Injury Fund and joint coverage recovery opportunities
• Regularly communicate claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful manner
• Notify management and develop reports for large exposure claims and comply with reinsurance reporting requirements
• Manage the claims litigation process to ensure timely and cost-effective claims resolution
• Monitor the expenses and effectiveness of managed care and investigation vendors
• Periodically travel to attend hearings, conferences and training sessions
• Attend and participate in claim file reviews with management and defense attorneys
• Coordinate and lead special projects or processes as assigned by management
• Assists with oversight and supervisory duties when the team supervisor is unavailable or as assigned by supervisor
• Support management with training and staff development
• Support management with vendor management activities

Continuously strives to improve our product and business results through innovation

Core Competencies

• Active learning
• Coachable
• Critical Thinking
• Results Oriented
• Time Management

Additional Qualifications

• 3 - 5 years of experience handling California workers’ compensation claims
• Excellent written and verbal communication skills
• Strong interpersonal and relationship building skills
• Exceptional time management and organization skills
• Strong analytical and critical thinking skills
• Ability to work independently and strategically problem solve
• 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
• Detail oriented

Travel Requirements

• Low level of domestic U.S. travel required (up to 5% - 10% of time)

Education

• Bachelors’ degree or equivalent insurance industry work experience
• AIC, ARM, CCP, or CPCU insurance designation preferred

Additional Company Details

The Company is an equal employment opportunity employer. 

The Company is an equal employment opportunity employer

We do not accept any unsolicited resumes from external recruiting agencies or firms.

The company offers a competitive compensation plan and robust benefits package for full time regular employees.

Salary Range: 65k-90k.

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.

While performing the duties of this job, the employee is regularly required to be seated for sustained periods of time; be able to use a keyboard; pick-up, pinch, or twist objects; must be able to communicate information accurately; distinguish sounds at normal levels and be able to receive information orally. The employee is occasionally required to move about the office to accomplish tasks; reach in any direction; raise or lower objects or move objects from place to place; and hold onto objects. Occasionally, the employee may need to move or exert force up to ten (10) pounds. The employee is regularly required to operate a computer and other office equipment, including a phone, copier and printer.

Sponsorship not Offered for this Role