Claims Representative

Manassas, VA
Oct 16, 2021
Oct 18, 2021
Accountant, IT
Full Time
Company Details: Responsibilities: BerkleyNet is an innovative workers compensation insurance provider that does all of our business online. Our goal? To make doing business Ridiculously Fast. Amazingly Easy.Job DescriptionThe Claims Representative is responsible for the investigation, evaluation, mitigation and resolution of an inventory of medical only and low complexity lost time workers compensation claims in multiple jurisdictions.Overall ResponsibilitiesInvestigates workers compensation claims by interviewing injured workers, witnesses, and policyholders to verify coverage and determine compensability and benefits dueCalculates and sets timely financial reserves and proactively manages reserve adequacy throughout claim lifecycleRecords and codes injured worker demographics, job information and accident information in companys claims management system and files necessary forms with state regulatory agenciesIssues timely payments to injured workers, medical providers and service vendors. Coordinates and actively manages medical treatment of injured workers to ensure timely rehabilitationNegotiates settlements of claims within designated authority with injured workers and attorneysMaintains and demonstrates knowledge of the Workers Compensation Act, adjudication process, and regulatory compliance framework in assigned jurisdictionsIdentifies and manages subrogation, Second Injury Fund and joint coverage recovery opportunitiesRegularly communicates claim activity and status updates to policyholders, injured workers and other interested parties in a professional, thoughtful and tactful mannerNotifies management and develops reports for large exposure claims and complies with reinsurance reporting requirementsManages the litigation process to ensure timely and cost effective claims resolutionMonitors the expenses and effectiveness of managed care and investigation vendorsActively participates in special projects as assigned by managementPeriodically travels to attend hearings, conferences and training sessionsAttends and participates in claim file reviews with management and defense attorneysContinuously strives to improve our product and business results through innovationCompletes continuing education and career development programs and training with guidance from supervisorObtain and maintain adjuster license in multiple jurisdictions as required Qualifications: Required Skills & CompetenciesManaging SelfEffective CollaborationEvidence-Based Decision MakingReflective ListeningCourageResilienceChallenge the Status QuoAdditional QualificationsExcellent written and verbal communication skillsStrong interpersonal and relationship building skills Exceptional time management and organization skillsStrong analytical and critical thinking skillsAbility to diplomatically manage conflictAbility to develop relationships within the organization and work effectively across departmentsStrong discretion and integrity in dealing with highly confidential and sensitive informationDetail orientedTravel RequirementsLow level of travel required (<10% of time)Ability to travel nationally to attend hearings, conferences and trainingsPhysical RequirementsWhile performing the duties of this job, the employee is regularly required to be seated for sustained periods of time; be able to use a keyboard; pick-up, pinch, or twist objects; must be able to communicate information accurately; distinguish sounds at normal levels and be able to receive information orally. The employee is occasionally required to move about the office to accomplish tasks; reach in any direction; raise or lower objects or move objects from place to place; and hold onto objects. Occasionally, the employee may need to move or exert force up to ten (10) pounds. The employee is regularly required to operate a computer and other office equipment, including a phone, copier and printer. EducationBachelors degree or equivalent insurance industry work experienceThe above job description is not intended to be an all-inclusive list of the duties and responsibilities of the job described, nor is it intended to be such a listing of the skills and abilities required to do the job. Rather, it is intended only to describe the general nature of the job. Additional Company Details: The Company is an equal employment opportunity employer. Additional Requirements: COVID-19 vaccine required unless prohibited by law.