WC Claims Representative 1

We’re a member company of W. R. Berkley Corporation, an A. M. Best A+ rated Fortune 500 holding company. Berkley is comprised of individual operating units that serve a defined insurance market segment. Berkley Risk is focused on providing self-insured entities program administration services and insurance operations which can include taking or sharing risk using Berkley paper. This capability allows us to customize both an insurance company option and a purely administrative option for our customers.

We’re a member company of W. R. Berkley Corporation, an A. M. Best A+ rated Fortune 500 holding company. Berkley is comprised of individual operating units that serve a defined insurance market segment. Berkley Risk is focused on providing self-insured entities program administration services and insurance operations which can include taking or sharing risk using Berkley paper. This capability allows us to customize both an insurance company option and a purely administrative option for our customers.

• Investigate claims for compensability by analyzing claims-related information and applying claim handling guidelines.
• Verify active policy/coverage on new claims and determine if claim involves medical benefits only or includes exposure for lost time.
• Establish case reserves consistent with exposure on new claims. Examine reserves on a regular basis and adjust reserves if there is a significant change in exposure.
• Serve and file state forms when required.
• Investigate subrogation issues on claims, and place responsible third parties on notice of our client’s subrogation interest. Pursue subrogation or transfer file as appropriate.
• Receive and respond to telephone inquiries. This includes but is not limited to contact with injured employees, employers and health care providers.
• Authorize payment of bills for reasonable and necessary medical treatment, expenses associated with claims investigations and obtaining records. Send bills and records for audit when appropriate.
• Authorize or deny medical benefits within established time frames.
• Manage caseload with assistance of computer-operated diary and maintain current diaries.
• Participate in on-going training opportunities to remain current on all aspects of claims handling and customer service.
• Ensure timely filing of regulatory documents via EDI (Electronic Data Interchange); submit applicable claims to Index Bureau Reporting (ISO) and document files as applicable.
• Provide additional levels of management and claim department operational support to include payment review/approval/input and complete scheduled or special project work as needed.

May perform other functions as assigned

• Minimum of two years office experience or post-high school education.
• Ability to interpret and evaluate limited medical and limited legal concepts.
• Analysis and decision-making skills.
• Good to excellent math and analytical ability.
• Good oral and written communication skills.
• Willing to learn and apply negotiation techniques.

Education 

• High school diploma or equivalent