Berkley Specialty Underwriting Managers is seeking a Senior Claims Examiner Workers Comp for our Irving, TX office. This position, under limited supervision, reviews, evaluates, negotiates and processes WC Claims of serious to significant complexity, makes recommendations for resolution, and litigation management as appropriate. Has contact with agents, claimants, and policy holders
- Responsible for the day to day management of serious to complex workers compensation claims.
- Conduct initial investigation to confirm coverage is in place for the loss and that the loss itself is compensable per state specific requirements, make quality, prompt contacts with employer, claimant, doctor and any witnesses, document and confirm initial diagnosis and prognosis.
- Ensure that the claim is adequately reserved, review and pay medical bills and expense bills timely and accurately, recognize and evaluate each case for subrogation potential, recognize potential fraud cases, document return to work and light duty efforts, accurately calculate, code and issue indemnity payments, promptly and accurately complete required internal Large Loss reports.
- Proactively manage all litigated claims by clearly documenting the litigation plan and budget, retaining competent counsel, communicating with counsel on a regular basis and clearly documenting the litigation action plan and strategy.
- Participate in claim reviews, which may require some travel.
- Bachelor's degree in business insurance or related field with at least 10 years experience in investigating and adjusting workers compensation claims.
- Texas Adjuster License required in area of adjusting specialty.
- Must have extensive understanding of WC Statutory benefits and state regulatory requirements in multiple jurisdictions.
- Demonstrates strong written and oral communications skills.
- Ability to draft communications that are clear, concise, complete and professional.
- Negotiation skills mandatory, and ability to interact with all levels of the organization.
- Demonstrates organizational skills while working on multiple projects.
- Working knowledge of Excel, Word, and general computer skills.