We have an opening in our San Diego, CA office for a Senior Claims Professional. The Senior Claims Professional manages a caseload of Workers Compensation indemnity cases from inception to resolution and assigns appropriate tasks to a Claims Assistant. This position requires a self-starter who can work under a minimum of direction, achieve defined results and accept ownership for their work product.
- Determine coverage for reported claims and take appropriate action on any coverage issues.
- Conduct and direct the investigation of reported claims to determine compensability and severity and to gather all other relevant information, including making three point contact telephone calls.
- Calculate appropriate reserves for each claim and ensure that reserves are adjusted as needed.
- Calculate and pay indemnity benefits.
- Ensure that other benefits are provided in accordance with the law.
- Develop and update a plan of action for the successful resolution of each claim.
- Make prompt, sound decisions on issues that arise in claims based on the best information available.
- Ensure compliance with applicable legal and internal standards.
- Ensure that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.
- Assign appropriate tasks to a Claims Assistant and ensure they are performed correctly and efficiently.
- Value the settlement value of claims and negotiate claim settlements.
- Foster a positive and close working relationship with other Company staff, including the call center, medical management, special investigations, legal, and nurse case management.
- Communicate effectively with individuals outside the company, including clients, medical providers, and injured workers.
- Bachelor's degree (B. A.) from four-year College or university; or two to five years related experience and/or training; or equivalent combination of education and experience.
- IEA designation with 30 hours of on-going education every 2 years and self-insurance certificate are preferred.
- To perform this job successfully, an individual should have expert skills in the following: Microsoft Word, PowerPoint, Excel and be proficient on applicable databases, systems and vendor software programs.
COMPREHENSIVE BENEFITS PACKAGE:
- Disability and AD&D
- Retirement & Savings Plan with 100% employer match up to 5% of salary
- Education Assistance Reimbursement
- Paid Vacation and Holidays
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, 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 and a AAA bond rating from Standard & Poor's. 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