The Claims Professional Trainee will successfully complete the Claims Training & Development Program, which includes classroom learning, hands-on experience and working under the mentorship and direction of a supervisor. Once training has been completed, this Claims Professional Trainee will actively manage a caseload of workers’ compensation medical only claims from inception to resolution.
- Successfully completes the Claims Training & Development Program, including completion of Stages 1 through 3 of the classroom training and demonstrating successful performance and development as a member of the Medical Only Unit.
- In classroom training, is attentive, takes notes, asks appropriate questions, participates successfully in exercises, and demonstrates mastery of the subject material.
- In the Medical Only Unit, asks appropriate questions, exhibits continuous improvement under the guidance of the supervisor, and demonstrates mastery of fundamental adjusting knowledge, skills, and strategy.
- Learns medical subjects including anatomy, physiology, terminology, pharmacology, causation, nature of injury, and diagnostic and treatment methodology.
- Learns legal subjects including relevant statutes, regulations, case law, and litigation processes.
- Learns to use the computer systems employed in the management of claims.
- Learns skills such as investigative and persuasive communication, negotiation, decision-making, documentation, and strategic planning.
- Determines coverage for new claims and takes appropriate action on any coverage issues.
- Conducts and directs the investigation of new claims to determine compensability and severity and to gather all other relevant information, including making three point contact telephone calls.
- Calculates appropriate reserves and ensures that reserves are adjusted as needed.
- Ensures that other benefits are provided in accordance with the law and that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings.
- Develops and updates a plan of action for the successful resolution of each claim.
- Manages each claim to an appropriate and successful resolution.
- Makes prompt, sound decisions on issues that arise in claims.
- Ensures that work is performed in accordance with Company standards, training, and supervisory direction.
- Fosters a positive and close working relationship with other Company staff, including the call center, medical management, special investigations, legal, nurse case management, the call center, client services, marketing, and underwriting.
- Bachelor's degree (B.A.) from four-year College or university is preferred; or equivalent combination of education and experience.
- Experience: Experience in the fields of law, medicine, insurance, workers compensation, telephonic communication, or negotiation is useful but not necessary.
- Language Ability: Able to read and interpret complex documents including statutes, regulations, legal opinions, legal letters, medical records, medical bills, medical resource materials, investigation reports, claim notes, and claim data fields. Able to write clear, concise reports accurately conveying complex and nuanced information. Able to write clear, effective correspondence on complex medical and legal points to people from all walks of life. Able to effectively present information and respond to questions with managers, clients, claimants, attorneys, medical providers, and others. Able to investigate, persuade, and negotiate over the telephone.
- 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. Familiar with the time value of money and reducing future streams of payments to a present value. Familiar with the concept of statistical likelihood as the basis for calculating the value of a possible financial outcome.
- 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.
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, 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.