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Senior Claims Examiner

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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-Larger Businesses and Group Association Members (Programs). The company’s distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves 11,000 policyholders and provides medical claims handling and claims management for policyholders as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company.

Company URL: https://www.peiwc.com

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 position will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. Acts in a fiduciary role on behalf of policyholders, negotiates claim settlements and manages subrogation. Senior Claims Examiner’s conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. The Senior Workers’ Compensation Examiner is expected to function with a degree of competency. The use of sound judgment coupled with consistent results is expected.

Key functions include but are not limited to:

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.
Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.

Qualifications

Bachelor’s degree preferred
5+ years claims management experience.
Professional certification as applicable to 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.
Professional certification as applicable to workers’ compensation required.

Additional Company Details

We do not accept unsolicited resumes from third party recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $95,000 - $116,000 • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. 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.

Average salary estimate

$105500 / YEARLY (est.)

min

max

$95000K

$116000K

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What You Should Know About Senior Claims Examiner, Berkley

As a Senior Claims Examiner at Preferred Employers Insurance, a Berkley Company, located in Walnut Creek, you will play a vital role in managing complex workers' compensation claims, ensuring that our policyholders receive the best care possible. You’ll be at the forefront of analyzing, investigating, and making critical decisions on claims, always with our policyholders' interests at heart. Your responsibilities will involve negotiating settlements, documenting claims to meet compliance standards, and applying your expertise in workers' compensation laws. You’ll be navigating through various claims, utilizing sound judgment to allocate reserves, and coordinating with vendors to streamline the investigation and litigation process. With your experience and skills, you’ll also take part in actively managing the ongoing litigation processes, ensuring that claims resolutions are both timely and cost-effective. We’re looking for someone who not only possesses strong negotiation and analytical skills but also someone who is committed to maintaining professional relationships with all parties involved. At Preferred Employers Insurance, we pride ourselves on our award-winning service and the support we offer to our employees, from competitive compensation to an extensive benefits package. If you’re ready to take your claims management career to the next level, we encourage you to apply and join our dynamic team in Walnut Creek.

Frequently Asked Questions (FAQs) for Senior Claims Examiner Role at Berkley

What are the responsibilities of a Senior Claims Examiner at Preferred Employers Insurance?

As a Senior Claims Examiner at Preferred Employers Insurance, your main responsibilities include analyzing and managing complex workers’ compensation claims, investigating claim details, negotiating settlements, ensuring compliance with industry regulations, and maintaining client relationships. You will also process claims payments, manage reserves, prepare state filings, and actively oversee the litigation process.