Senior Claims Specialist - California Workers Compensation (Remote)

Company Details

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

Responsibilities

As a Sr. Claims Specialist, you will be responsible for handling some of our highest exposure and most complex workers’ compensation claims in your team’s assigned jurisdictions. You’ll serve as a Subject Matter Expert (SME) for all technical claims handling activities, including regulatory compliance, serve as the primary liaison for key internal and external business partnerships and programs, lead special projects and programs, and lead claims related account management activities for large clients.

• Serves as claims technical Subject Matter Expert (SME) for other claims adjusting staff in assigned jurisdictions
• Assume full-responsibility of claims related account management activities for our large clients and serve as the Claims liaison and primary point of contact and collaborate closely with Business Development and Underwriting teams to deliver and maintain a high-level service
• Identify and notify management of any unfavorable trends related to account management
• Actively work with Business Development and Underwriting teams to monitor loss ratio for assigned accounts
• Participate in client meetings for training on claims issues and assist with claims service meetings for new accounts as requested
• Effectively investigate, evaluate, mitigate and resolve a pending inventory of litigated and high exposure workers’ compensation claims within delegated authority and in accordance with performance standards
• Promptly notifiy claims management of high-exposure claims and assist in compliance with reinsurance reporting requirements
• Serve as primary liaison with key internal & external business partners and vendors and actively work to develop maintain, and improve the partnerships and programs
• Monitor costs and effectiveness of internal and external business partners and vendors
• Assist claims adjusters and management with the development of claims investigation and resolution action plans
• Maintain and demonstrate high-level of knowledge of the Workers Compensation Act and Rules and Regulations in assigned jurisdictions
• Serve as the Subject Matter Expert (SME) and go to person for all technical aspects of claims handling including coverage, disability benefit management, medical management, file management, litigation management, subrogation, reserving and settlement in their assigned jurisdictions
• Actively participate in the training and development of claims adjusters through mentoring and conducting training for new hires and existing staff
• Identify and addresses areas for coaching and training needs of claims adjusters and communicates needs with claims management and assists in development of action plans for improvement
• Coordinate relevant legal training seminars for claims staff in assigned jurisdictions
• Visibly supports the overall claims adjusting and managed care functions in assigned jurisdictions
• Assist claims management in monitoring and researching jurisdictional case law and statutory legal trends
• Communicate case and statutory law and legal trends that impact claims handling
• Demonstrate the use of tact and discretion in all communications and provides a positive contribution to the morale of the claims department
• Lead special projects as assigned by senior claims management
• Continuously strives to improve our product and business results through innovation
• Obtain and maintain adjuster license in multiple jurisdictions as required
  
  

Qualifications

• Minimum of 7-9 years of technical claims handling experience with a heavy emphasis on workers’ compensation claims in multiple jurisdictions
• Supervisory experience a plus, but not required
• Consistently display a high-level of ownership, drive and accountability
• Acts as an informal leader
• Excellent written, verbal, interpersonal and relationship building skills
• Exceptional time management and organization skills
• Strong insurance business acumen and leadership skills
• Ability to work independently and strategically problem solve
• Strong analytical and critical thinking skills
• 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
• Display a high-degree of attention to detail
  
  

Education Requirement

• Bachelor’s degree or equivalent work experience
• AIC, ARM, CCP or CPCU insurance designation preferred
  
  

Additional Company Details

The above job description is not intended to be an “all-inclusive” list of the duties and responsibilities of the job described, nor is it intended to be such a listing of the skills and abilities required to do the job. Rather, it is intended only to describe the general nature of the job.

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.
• Base Salary Range: $85k-$115k
  
  

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

Travel Requirements

Low to moderate level of travel (up to 10% - 15% of time)

Ability to travel nationally to attend legal hearings, conferences, trainings, file reviews, audits and business partner meetings

Sponsorship Details

Sponsorship not Offered for this Role