Claims Investigations Coordinator
Berkshire Hathaway Homestate Companies - San Francisco, CA

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Berkshire Hathaway Homestate Companies, a nationwide family of insurance carriers, is accepting applications to fill its newly created Claims Investigations Coordinator position with a bright and dynamic individual who will spearhead BHHC’s efforts against fraudulent claims for workers’ compensation benefits. This is a rare opportunity to have a significant and lasting impact on the success of a company widely recognized for its financial strength and commitment to excellence. The Claims Investigations Coordinator will join a leadership team in designing and implementing a groundbreaking program for the detection, investigation, and resolution of fraudulent claims that will not only protect the interests of the company, but also help preserve the integrity of the workers’ compensation system and serve as a model for the industry. The successful candidate will combine strong academics and interpersonal skills with practical experience in an analytical or investigative role involving litigation, health care, business, journalism, insurance, and/or other related field. A demonstrated ability to work knowledgably and collaboratively with a cross-section of professionals – claims adjusters, defense attorneys, field investigators, insurance regulators, law enforcement officers, prosecutors and healthcare practitioners, among others – is essential, as are an abiding commitment to the truth, an appetite for exposing wrongs, and a keen understanding the social and financial consequences of fraud.

BASIC JOB FUNCTION:

The Claims Investigations Coordinator is responsible for managing investigations of potentially fraudulent claims for workers’ compensation benefits.

ESSENTIAL RESPONSIBILITIES AND ACCOUNTABILITIES:

• Develop and implement a comprehensive approach to the prevention, detection, investigation, litigation, and prosecution of fraudulent workers’ compensation claims submitted to the Company.
• Manage a first-rate panel of outside private investigation firms, monitoring and evaluating the each vendor’s performance based on results, methods, timeliness, responsiveness, efficiency, ethics, and overall effectiveness.
• Analyze surveillance videos, investigative reports, background reports, and other investigative materials to assess their potential value in defending against potentially fraudulent claims.
• Assist in-house claims adjusters in identifying potential avenues of investigation and making effective use of investigative findings to reduce the Company’s exposure to fraudulent claims.
• Maintain a broad understanding of the medical, legal, and insurance-related procedures and terminology used in the handling and investigation of workers’ compensation claims.
• Prepare detailed reports and presentations for Company management regarding investigative methods, objectives, findings, and recommendations accompanied by realistic assessments of the Company’s legal and financial exposure.
• Prepare reports documenting compliance with statutory and regulatory requirements as well as Company policies governing investigative methods, practices, training, and reporting.
• Prepare clearly written, documented referrals of potentially fraudulent claims for government authorities and respond promptly to requests for additional information from those authorities.
• Coordinate effectively with other members of the Special Investigations Unit and with key internal partners – including Medical Bill Review, Utilization Review, Resolution, Underwriting, and Legal – to share information and expertise, define investigative strategies and goals, and maximize the use of investigative findings to protect the interests of the Company.
• Coordinate with in-house and outside counsel in the investigation, litigation, negotiation, and/or settlement of disputes with claimants suspected of defrauding the Company.
• Provide testimony in a variety of legal settings, including depositions, trials and sentencing hearings.
• Devise and provide training to Company employees in the identification and management of potentially fraudulent claims.
• Keep abreast of claimant-fraud patterns and trends both locally and nationally.
• Continually expand the Special Investigations Unit’s network of contacts and sources in the medical, legal, academic, insurance, and law-enforcement communities.
• Maintain the highest level of technical competency in all relevant aspects of the investigative process. Participate in Company-approved training courses and in professional organizations.
• Promote the Company’s culture by upholding the highest standards of collaboration, performance, and ethical conduct.

QUALIFICATIONS:

• Experience and Education: Bachelor’s degree from an accredited college or university and at least two years of experience in an analytical or investigative capacity in law, health care, business, insurance, journalism or related field. Experience as a workers’ compensation attorney, hearing representative, and/or claims adjuster is helpful but not required.
• Language Ability: Able to read, analyze, and interpret investigation reports, statutes, regulations, contracts, medical reports, medical bills, financial reports, and legal documents. Able to understand medical and legal terminology. Able to respond effectively to technical inquiries or complaints from Company employees, external sources, and regulatory or auditing entities. Able to effectively present information and respond to questions when interacting with managers, clients, claimants, attorneys, medical providers, witnesses, and others. Able to formulate effective questions and elicit pertinent facts from people of all ages and backgrounds. Able to write clear, effective correspondence on complex issues. A working knowledge of Spanish is advantageous but not required.
• Math Ability: Able to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Able to compute rate, ratio, and percent.
• Reasoning Ability: Able to apply common-sense understanding to carry out instructions furnished in written, oral, or diagram form. Able to deal with problems involving several concrete variables in standardized situations.
• Computer Skills: Knowledge of Microsoft Office software. Able to quickly master proprietary and vended software applications.

OUR COMPREHENSIVE BENEFITS PACKAGE:

• Health
• Dental
• Vision
• Life
• Disability and AD&D
• Retirement & Savings Plan with 100% employer match up to 5% of salary
• Education Assistance Reimbursement
• Paid Vacation and Holidays

ABOUT US:

The Berkshire Hathaway Homestate Companies (BHHC) is a group of six insurance companies that are part of the Berkshire Hathaway Insurance Group, headquartered in Omaha, Nebraska. Our Workers Compensation Division provides premier workers compensation insurance coverage to employers across the country, with offices in San Francisco, San Diego, Pasadena, Omaha, Alpharetta, St. Louis, Atlanta, and Dallas.

As a member of the Berkshire Hathaway insurance group, BHHC has earned an enviable record of success in the insurance industry that is supported by an A++ A.M. Best rating, the highest rating they award insurance carriers. Our corporate size enables our organization to react swiftly and effectively to opportunities in the insurance marketplace. At the same time, our financial strength provides our agents and insureds the security rarely available in a
regional specialty carrier.

We value each individual and recognize that attracting and retaining high quality talent is essential to the success of our company. Our structure minimizes bureaucracy and creates an environment that encourages our employees to see the direct effects of their hard work throughout the company. Each division provides hands on training and maintains a small company feel, creating an atmosphere in which 'team players' thrive.

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