Workers' Compensation Claims Specialist – Complex

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $100k - $125k / year

⏰ Full Time

🟠 Senior

🔴 Lead

📋 Claims Specialist

👻 Ghost score 0%

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biBerk Business Insurance

WebsiteLinkedInAll Job Openings

51 - 200 employees

🛡️ Insurance

🤝 B2B

💸 Finance

Insurance • B2B • Finance

biBerk Business Insurance is a digital-first insurance provider focused on small business insurance, offering policies such as workers' compensation, professional liability (E&O), general liability, business owners policies (BOP), commercial auto, umbrella, and cyber coverage. Part of the Berkshire Hathaway Insurance Group and backed by A++ rated carriers, biBerk lets small businesses get online quotes, purchase policies, manage claims and documents, and access resources to simplify insurance. The company serves a wide range of small business industries (e. g. , restaurants, retail, contractors, IT, healthcare) and emphasizes instant coverage, cost savings, and direct-to-business underwriting.

📋 Description

• Investigate coverage, determine compensability, and manage high-exposure Workers’ Compensation claims involving catastrophic injuries and complex cases • Establish and update reserves throughout the life of each claim and document supporting rationale • Resolve claims within authority and make independent case value recommendations to senior leadership for cases exceeding authority • Participate in reserving, pricing, and strategy discussions with senior leadership • Collaborate with outside defense counsel to manage litigated files according to litigation management guidelines • Partner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and timely medical-bill submission • Ensure compliance with state and federal Workers’ Compensation regulations • Provide customer service to policyholders, agents, injured workers, medical providers, legal contacts, and vendors • Follow escalation and reporting requirements for claims with significant exposure • Develop resolution strategies for complex losses using internal and external resources • Document claim files according to company and regulatory guidelines • Identify subrogation potential and red flags requiring SIU involvement • Train new team members and serve as a technical resource to less experienced claims representatives • Report to the Workers’ Compensation Complex Claims Team Lead

🎯 Requirements

• Active adjuster license required or SIP • 10+ years of experience handling complex workers’ compensation claims • Multi-state Workers’ Compensation claims experience; California, Arizona, and Colorado jurisdiction experience preferred • Comprehensive knowledge of Workers’ Compensation regulations, laws, and best practices • Experience with structured settlements and Medicare Set-Asides • BA/BS degree required • AIC, SCLA, CPCU, or other industry designation a plus • Strong analytical, organizational, leadership, communication, negotiation, and time-management skills • Ability to work independently, meet deadlines, multitask, prioritize tasks, and work under pressure • Ability to work in a fast-paced, collaborative, virtual office environment • Proficiency with MS Word, Excel, and internet applications • High attention to detail and sound judgment in sensitive situations • Advanced verbal and written communication skills for internal and external stakeholders • Ability to maintain continuing education requirements

🏖️ Benefits

• Medical (PPO/HDHP), vision, disability, and life insurance • Enhanced dental plan with orthodontia coverage • Generous PTO plan • Paid company holidays and 4 floating holidays • Paid parental leave • Employee Retirement Savings Plan/401(k) with company match and immediate vesting • Education Assistance Program offering 100% upfront tuition reimbursement after 6 months of service for approved degree programs • Service Recognition Program with a monetary award toward a vacation every 5 years of employment • Wellness Initiatives including Fitness Center and Weight Watchers Reimbursement programs • Voluntary accident, critical illness, and hospital indemnity benefits • Employee discount and rewards program on travel, tickets, electronics, home, and more • Fully remote work arrangement • Occasional travel to attend mediations, trainings, and/or department meetings