Complex Claims Specialist - Workers Western

All Jobs >
Complex Claims Specialist - Workers' Compensation (Western USA)

Complex Claims Specialist - Workers' Compensation (Western USA)
Fully Remote
• BHDIC Claims

Full-time

Description

Berkshire Hathaway Direct Insurance Company (BHDIC) is the home of commercial small business insurance products biBerk Business Insurance and THREE by Berkshire Hathaway. Our Claims Department is looking for an experienced claims specialist with a strong background in complex Workers' Compensation claims. This role handles a caseload of highly complex/high-severity Workers' Compensation claims and requires a comprehensive knowledge of Workers' compensation regulations, laws, and best practices.

This role will report to the Workers' Compensation Complex Claims Team Lead. Multi-state experience handling Workers' Compensation claims in the following jurisdictions is preferred:
California, Arizona, Colorado, Wyoming, Texas, Oklahoma.

Location:

This is a full-time remote position. This position may require occasional travel to attend mediations, trainings, and/or other related department meetings.

The Complex Claims Specialist will be responsible for, but not limited to:

• Investigate coverage, determine compensability, and manage a pending of high exposure Workers' Compensation claims involving catastrophic injuries and complex cases
• Proactively establish and update reserves throughout the life of the claim to reflect claim exposure and document supporting rationale
• Resolve claims within authority and make independent case value recommendations to senior leadership on cases which exceed authority
• Participate in reserving, pricing and strategy discussions with senior leadership
• Collaborate with outside defense counsel to effectively manage litigated files according to established litigation management guidelines
• Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills
• Ensure compliance with state and federal Workers' Compensation regulations
• Provide exceptional customer service to policyholders, agents, injured workers, medical providers, legal, and vendors
• Follow escalation and reporting requirements on claims with significant exposure
• Develop creative resolution strategies to manage losses involving complex issues, effectively utilizing appropriate internal and external resources
• Document claim files in accordance with company and regulatory guidelines
• Identify subrogation potential and red flags that require SIU involvement
• Train new team members
• Act as a technical resource to less experienced claims representatives
• Maintain continuing education requirements

Requirements

• 10+ years of experience handling complex workers' compensation claims
• Excellent organizational, leadership, communication and time management skills
• Experience with structured settlements and Medicare Set-Asides
• Ability to work in a fast-paced, collaborative, virtual office environment
• Strong analytical, organizational, and time management skills
• Excellent written and verbal communication skills
• Ability to work independently and meet assigned deadlines
• Ability to multi-task and effectively prioritize tasks with frequent interruptions
• Proficiency with MS Word, Excel and internet applications
• Highly attentive to details
• Able to work under pressure and execute good judgment in sensitive situations
• Advanced verbal and written communication skills are essential for interacting with internal and external stakeholders

• AIC, SCLA, CPCU or other industry designation a plus

biBerk is where commercial insurance buyers can obtain coverage for their businesses from insurers of the Berkshire Hathaway group of Insurance Companies, one of the best capitalized insurance groups in the world. Our ultimate parent, Berkshire Hathaway Inc. () is a holding company with diversified interests in a host of industries, including insurance, energy, transportation and manufacturing. Most policies issued through  will be underwritten by Berkshire Hathaway Direct Insurance Company ("BHDIC"), which is an AM Best rated A++ insurer.

BHDIC is…