Sr. Claims Examiner - job 1 of 2

Company Details

 

W. R. Berkley Corporation, founded in 1967, is one of the nation’s premier commercial lines property casualty insurance providers. Founded in 2004, Berkley Environmental has underwriting and account executive units in seven regions. Berkley Environmental offers an array of coverages for virtually all classes traditionally known to have environmental liability exposures on both an admitted and non-admitted basis. We provide a comprehensive portfolio of commercial property casualty insurance, automobile liability and workers’ compensation, along with claim services, providing expertise to meet the unique business needs of our customers.

 

Company URL:  https://berkleyenvironmental.com/

 

The company is an equal opportunity employer.

Responsibilities

Under limited supervision, review, evaluate, negotiate and processes WC Claims of moderate/severe/catastrophic complexity, provide recommendations and strategies for resolution, and litigation management as appropriate. Collaborate with internal and external clients, and often interact with agents, claimants, and policyholders.

 

Key functions include but are not limited to:

• Analyze and process workers’ compensation claims by investigating and gathering information to determine compensability and exposure on claims, handling all national lost time claims.
• Calculate and assign timely and appropriate reserves on claims and monitor reserve adequacy throughout the life of the claim.
• Develop and manage claims updating action plans as the claim progresses and bring the claim to an appropriate and timely resolution.
• Accurately calculate and timely pay benefits due pertaining to the jurisdictional guidelines.
• Operate within designated authority level and time constraints pertaining to payments and resolutions based on specific jurisdictional protocol and guidelines.
• Timely file appropriate forms per jurisdictional protocol, within statutory limits and per EDI requirements.
• Participate in claim reviews, which may require limited travel, and timely production of claim reports.
• Coordinate vendor referrals for nurse case management and occasional investigations.
• Use appropriate cost containment techniques including strategic vendor partnerships to mitigate overall cost of claims.
• Manage claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
• Frequently collaborate with all appropriate parties involved with the claim, and clearly document that collaboration.
• Maintain professional internal and external client relationships.
• Actively execute timely and appropriate claims activities/diaries to ensure consistent delivery of quality claims services.
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Qualifications

• Demonstrates strong written and oral communications skills.
• Ability to draft communications that are clear, concise, complete, and professional.
• Negotiation skills mandatory, and ability to interact with all levels of the organization.
• Demonstrates organizational skills while working on multiple projects, diaries or activities.
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Additional Company Details

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 which for this role include: • Base Salary Range: $60,000-1$15,000 • Eligible to participate in annual discretionary bonus. • 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.

Sponsorship Details

Sponsorship not Offered for this Role