Claims Representative

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 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 manage reserve adequacy throughout claim lifecycle Record and code injured worker demographics, job information and accident information in the company’s claims management system and file 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 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 Actively participate in special projects as assigned by management Periodically travel to attend hearings, conferences and training sessions Attend and participate in claim file reviews with management and defense attorneys Continuously strive to improve our product and business results through innovation Obtain and maintain adjuster licenses in assigned jurisdictions where required Qualifications 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 Education Bachelor’s degree or equivalent insurance industry work experience Additional Company Details 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. Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit‑Sharing plans. 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 level of domestic U.S. travel required (up to 5% – 10% of time) Sponsorship Details Sponsorship not offered for this role #J-18808-Ljbffr