Job Details

Company Details

Preferred Employers Insurance, a Berkley Company specializes in providing workers compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid?Large Businesses and Group Association Members (Programs). Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry?rating organization, AM Best & Company. The company is an equal opportunity employer.

Responsibilities

The Senior Workers Compensation Examiner is responsible for the analysis and management of complex workers compensation claims. This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims. The role acts in a fiduciary role on behalf of policyholders, negotiates claim settlements and manages subrogation.

Key Functions

• Analyzes and processes workers compensation claims by investigating and gathering information to determine the exposure on the claim.


• Negotiates settlement of claims up to designated authority level and makes claims payments.


• Processes complex or technically difficult claims.


• Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim.


• Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.


• Develops and manages claims through well?developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.


• Prepares necessary state filings within statutory limits.


• Actively manages the litigation process; ensures timely and cost?effective claims resolution.


• Coordinates vendor referrals for additional investigation and/or litigation management.


• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.


• Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.


• Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner.


• Frequently communicates with all appropriate parties involved with the claim.


• Refers cases as appropriate to management.


• Maintains professional client relationships.

Qualifications

• Bachelors degree preferred.


• 5+ years claims management experience.


• Professional certification in workers compensation required.


• WCCP Preferred.


• In depth knowledge of appropriate insurance principles and laws for workers compensation.


• Strong written and verbal communication skills.


• Strong organizational skills.


• Strong negotiation skills.


• Strong analytical and interpretive skills.


• PC literate.

Benefits

The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include:

• Base Salary Range: $100,000 $120,000


• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit?Sharing plans.

Sponsorship not offered for this role.