Berkshire Hathaway Homestate Companies
Senior Claims Professional (Workers Compensation)
Berkshire Hathaway Homestate Companies, San Diego, California, United States, 92189
WHAT WE'RE LOOKING FORBerkshire Hathaway Homestate Companies, Workers Compensation Division, has an immediate opportunity for experienced Claims Professionals (Adjusters). This position requires a self-starter who can work under minimum direction, can achieve defined results, and is willing to accept ownership for their work product.The Senior Claims Professional is responsible for the management of a complex caseload of workers compensation indemnity claims from inception to resolution. This individual works under general supervision with elevated reserve and settlement parameters and is encouraged to participate in special projects focused on process efficiency.
ESSENTIAL RESPONSIBILITIES
Helps injured workers achieve rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support.Effectively communicates with injured workers and employers. Demonstrates expertise and empathy, building trust and moving the claim forward, including timely three-point contacts on all new losses.Manages claims with an outcome-based and resolution focus. Demonstrates highly effective strategic plans for future handling that are well outlined in plans of action and followed through in a timely fashion.Demonstrates effective decision making in compensability determinations and benefit authorizations (within designated authority parameters). Proactively utilizes resources such as Medical Management, SIU, Subrogation, Recovery and Legal to ensure accurate determinations in compensability, causal relationship, appropriate medical treatment, and to achieve favorable outcomes.Prepares and maintains timely, accurate reserves on all claims for expected future costs of medical treatment, benefits and other elements in accordance with Claims Handling Guidelines. Ensures reserves are escalated and approved as appropriate. Ensures there is appropriate reserve documentation in the file.Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.Reduces fraud through early identification and escalation.Effectively manages defense attorneys. Demonstrates excellence in litigation management by being prepared for hearings in a timely manner and appropriately considering exposures, settlement options, and other legal issues.Reviews and approves vocational rehabilitation plans.Effectively manages vendors and providers. Identifies need for assignment and removal of vendors and makes effective use of vendor expertise while maintaining ownership of the claim.Demonstrates expertise in technical aspects of claim management. Works with Medicare Set Asides, Structured Settlements and/or Part B issues.Maintains effective relationships with internal and external service partners, including participation in periodic telephonic claims reviews.Calculates and pays benefits in accordance with the law. Ensures that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings.WHAT YOU'D BRING TO THE ROLE
EDUCATION: Minimum of a High School diploma required or equivalent certificate required; Bachelor's degree from four-year College or university preferred.EXPERIENCE: Minimum of five years of indemnity adjusting experience managing large and/or complex claims and accounts within a workers’ compensation carrier required.Maintains qualifying educational criteria to adjust workers’ compensation claims for the State of California; Self-Insured certification preferred.Inquisitive, critical thinker; agile learner with adaptive, smart time management skills.To perform this job successfully, an individual should have expert skills in the following: Microsoft Word, PowerPoint, Excel and be proficient on applicable databases, systems and vendor software programs.WHAT WE OFFER
Reasonable caseload with in-house Medical Management support (UR, Med Bill Review, Resource Nurses); In-house Claims Assistant support.Work-Life Balance.Work From Home Program (up to 2 days per week).Modern Office Setting.Free On-Site Fitness Facility.Free On-Site Garage Parking.BENEFITS
Paid Time Off.Paid Holidays.Retirement Savings Match.Group Health Insurance (Medical, Dental, and Vision).Life and AD&D Insurance.Long Term Disability Insurance.Accident and Critical Illness Insurance.Flexible Savings Accounts.Paid Community Volunteer Day.Employee Assistance Program.Tuition Reimbursement Program.Employee Referral Program.Diversity, Equity and Inclusion Program.
$86,000 - $102,000 a yearABOUT US
With more than 50 years in business, Berkshire Hathaway Homestate Companies has grown from a regional organization to a national insurance group, offering insurance products from coast to coast. Relationships are the cornerstone of our culture, and we believe in doing the right thing. That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success. Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts. At BHHC we embrace diversity and foster an environment where our people can be their authentic selves. Our differences make us stronger and better together, which fosters a harmonious workplace—something we truly value. We’ve created an approachable and collaborative atmosphere. Here you’ll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work. Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.
DISCLAIMERS
This job posting is not intended as an exhaustive listing of responsibilities and qualifications. A copy of the job description is available upon request. The Work from Home Program is subject to certain eligibility requirements. The salary range is an estimate. The actual salary may be above or below the range depending on experience, skill, and education.
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ESSENTIAL RESPONSIBILITIES
Helps injured workers achieve rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support.Effectively communicates with injured workers and employers. Demonstrates expertise and empathy, building trust and moving the claim forward, including timely three-point contacts on all new losses.Manages claims with an outcome-based and resolution focus. Demonstrates highly effective strategic plans for future handling that are well outlined in plans of action and followed through in a timely fashion.Demonstrates effective decision making in compensability determinations and benefit authorizations (within designated authority parameters). Proactively utilizes resources such as Medical Management, SIU, Subrogation, Recovery and Legal to ensure accurate determinations in compensability, causal relationship, appropriate medical treatment, and to achieve favorable outcomes.Prepares and maintains timely, accurate reserves on all claims for expected future costs of medical treatment, benefits and other elements in accordance with Claims Handling Guidelines. Ensures reserves are escalated and approved as appropriate. Ensures there is appropriate reserve documentation in the file.Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.Reduces fraud through early identification and escalation.Effectively manages defense attorneys. Demonstrates excellence in litigation management by being prepared for hearings in a timely manner and appropriately considering exposures, settlement options, and other legal issues.Reviews and approves vocational rehabilitation plans.Effectively manages vendors and providers. Identifies need for assignment and removal of vendors and makes effective use of vendor expertise while maintaining ownership of the claim.Demonstrates expertise in technical aspects of claim management. Works with Medicare Set Asides, Structured Settlements and/or Part B issues.Maintains effective relationships with internal and external service partners, including participation in periodic telephonic claims reviews.Calculates and pays benefits in accordance with the law. Ensures that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings.WHAT YOU'D BRING TO THE ROLE
EDUCATION: Minimum of a High School diploma required or equivalent certificate required; Bachelor's degree from four-year College or university preferred.EXPERIENCE: Minimum of five years of indemnity adjusting experience managing large and/or complex claims and accounts within a workers’ compensation carrier required.Maintains qualifying educational criteria to adjust workers’ compensation claims for the State of California; Self-Insured certification preferred.Inquisitive, critical thinker; agile learner with adaptive, smart time management skills.To perform this job successfully, an individual should have expert skills in the following: Microsoft Word, PowerPoint, Excel and be proficient on applicable databases, systems and vendor software programs.WHAT WE OFFER
Reasonable caseload with in-house Medical Management support (UR, Med Bill Review, Resource Nurses); In-house Claims Assistant support.Work-Life Balance.Work From Home Program (up to 2 days per week).Modern Office Setting.Free On-Site Fitness Facility.Free On-Site Garage Parking.BENEFITS
Paid Time Off.Paid Holidays.Retirement Savings Match.Group Health Insurance (Medical, Dental, and Vision).Life and AD&D Insurance.Long Term Disability Insurance.Accident and Critical Illness Insurance.Flexible Savings Accounts.Paid Community Volunteer Day.Employee Assistance Program.Tuition Reimbursement Program.Employee Referral Program.Diversity, Equity and Inclusion Program.
$86,000 - $102,000 a yearABOUT US
With more than 50 years in business, Berkshire Hathaway Homestate Companies has grown from a regional organization to a national insurance group, offering insurance products from coast to coast. Relationships are the cornerstone of our culture, and we believe in doing the right thing. That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success. Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts. At BHHC we embrace diversity and foster an environment where our people can be their authentic selves. Our differences make us stronger and better together, which fosters a harmonious workplace—something we truly value. We’ve created an approachable and collaborative atmosphere. Here you’ll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work. Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.
DISCLAIMERS
This job posting is not intended as an exhaustive listing of responsibilities and qualifications. A copy of the job description is available upon request. The Work from Home Program is subject to certain eligibility requirements. The salary range is an estimate. The actual salary may be above or below the range depending on experience, skill, and education.
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