Berkshire Hathaway Direct Insurance Company - Complex Workers' Compensation Claims Specialist (Northeastern USA)
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Complex Workers' Compensation Claims Specialist (Northeastern USA)
Berkshire Hathaway Direct Insurance Company
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Complex Workers' Compensation Claims Specialist (Northeastern USA)
Fully Remote •
BHDIC Claims
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Job Type
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 are preferred: CT, DE, MI, NH, RI , VA, MA, PA, MN and WV.
Location: This is a full-time remote position. This position may require occasional travel to attend mediations, trainings, and/or other related department meetings.
Job Responsibilities
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
Qualifications
Knowledge and Experience:
Active adjuster license required
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
Strong negotiation skills
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
Education:
BA/BS degree required
AIC, SCLA, CPCU or…