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As a Sr. Premium Auditor, you will apply advanced practical knowledge and will work closely with team leads and managers to align and support the Premium Audit function within the Underwriting Department. In this role, you will analyze data to make decisions that drive results and improve operational efficiencies. You will lead key tasks and projects to completion and have defined customer-focused responsibilities through the premium audit lifecycle.
A Sr. Premium Auditor fulfills the primary responsibilities of the role by executing the following duties and tasks:
- Analyze information from third-party reports of our insured’s business operations and risks, including examining and verifying class code and business ownership and financial information to ensure proper risk classification and accuracy of premium
- Discuss issues with the insured, agent, broker and/or audit vendor to ensure understanding of changes in exposure and premium resulting from an audit to maintain good customer relations
- Analyze data to make decisions that drive results and improve efficiencies and quality in processes and products
- Manage daily responsibilities and competing priorities to be accountable for delivering results
- Lead or participate in departmental and cross-functional project teams
- Communicate with policyholders, agents, brokers, and vendors via phone, instant messaging or email to promptly respond to inquiries and service requests, and resolve issues
- Generate and implement solutions in your daily work and assigned projects
- Formulate data metric driven solutions to department issues and inform the department on progress with special tasks or projects assigned to you
- Identify issues and thoroughly vet the scope of the issue to determine action plan for resolution
- Effectively follow-up on and complete complex work activities
- May be asked to partner with leadership or other higher-level professionals to provide input on resource development and allocation for various projects
- Assist leadership where needed in department planning and budgeting process
As a Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of medical only and lost time workers’ compensation claims of moderate complexity in multiple 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 manages 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
- Demonstrate a working knowledge 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
Respond in a timely manner to communications from policyholders, injured workers, and other interested parties
- Notify management and develops reports for large exposure claims and complies 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
- Actively participate in special projects as assigned by management
- Periodically travel to attend hearings, conferences and training sessions
- Attend and participates in claim file reviews with management and defense attorneys
- Continuously strives to improve our product and business results through innovation
- Obtain and maintain adjuster licenses in assigned jurisdictions where required
As a Business Analyst Intern, you will be assisting the Business Analyst group as a liaison between stakeholders and technology partners to review, analyze and evaluate business systems, operational processes and customer needs to identify opportunities for innovation and collaborate with cross-functional teams to create and implement solutions.
In this role, you will participate in tasks, projects or initiatives that involve data entry, analyzing data, collaborating with subject matter experts and research to identify problems, and propose solutions that drive innovation and our organizational goals.
• Administrative tasks involving issue submissions through Atlassian software
• User acceptance testing and guide creation
• Collaborate with end users and stakeholders to assist in development and translation of business requirements for project and supporting deliverables
• Suggest changes to business stakeholders using data and analytics to support recommendations
• Manage workload by balancing competing priorities
• Conduct meetings or presentations informing the business on progress within tasks/projects assigned
• Effectively communicate insights and plans to cross-functional team members and management
• Identifies issues and investigate the scope of the issue
• Participate in cross functional project teams as determined by management
The Vice President of Claims has overall executive management responsibility for the claims function. S/he impacts our company top to bottom, leading on outcomes, people, innovation, data analysis, and best practices. This role is responsible for the overall direction of claims management and practices of the company including oversight for developing, implementing, and managing policies and procedures to enhance the processing, investigation and settlement of claims. Key functions include but are not limited to:
- Creating vision, planning and executing to develop a best in class claims organization
- Direction, leadership, development and management of all claims personnel; adjusters, technical staff, data, operations, legal, etc. The adjusters have varying experience levels, establishing and monitoring authority levels, making claim assignments and approving payments and reserve requests
- Direction, leadership, and development of the department’s internal quality audit process to ensure compliance of best claim practices, processes and procedures
- Develop and implement policies and procedures which meet the needs of the company, customers, regulatory requirement, and audit controls.
- Establish the organizational structure, environment, and accountability of the claims operations in order to deliver services to the business. The development and use of metrics and analytics to identify trends and drives the department’s success
- Develop and manage relationships with outside vendors, consultants, contractors, and other Berkley companies in line with company policies and guidelines.
- Developing and maintaining claim/ legal resources to include attorneys, adjusters and expert witnesses and related responsibilities to include internal and external litigation guidelines, panel counsel and litigated claim outcomes
- Collaboration with multiple departments to ensure sound reserving practices are in place and maintained
- Ensuring compliance requirements are met through Large Loss Reporting to the WRB organization and reinsurers.
- Attracting World Class Talent to the department
- Supports and communicates Claim philosophies and builds business relationships with customers