Berkshire Hathaway

Diversified holding company across insurance, utilities

Experienced Claims Adjuster

Claims AdjudicationConfirmed live in the last 24 hours

Full-timeSan Diego, CA, USA$70.3k - $95.1k /yr

About the Job

Requirements

A high school diploma or equivalent certificate is required.
A Bachelor's degree from a four-year college or university is preferred.
Must be designated as a Claims Adjuster or Experienced Claims Adjuster under the California Code of Regulations and have completed the minimum continuing education credits required to adjust workers' compensation claims in California.
At least three years of indemnity adjusting experience managing large or complex claims and accounts within a workers' compensation carrier is required.
Must maintain the qualifying educational criteria to adjust workers' compensation claims in California.
Must be proficient in the Microsoft Office Suite and applicable databases, systems, and vendor software programs.

Responsibilities

Manage a caseload of workers' compensation indemnity claims from inception to resolution, including initial investigation and compensability determination, reserve analysis and strategic planning, timely benefit administration, and coordination of medical care and legal processes.
Investigate reported claims through three-point contact calls to determine coverage, compensability, and severity, gather relevant information, document findings thoroughly, and escalate investigations when appropriate.
Calculate appropriate reserves for each claim and adjust reserves as needed under authority guidelines.
Calculate and administer benefits in accordance with statutory requirements, including timely issuance of appropriate notices and filings.
Develop and update a Plan of Action for successful resolution of each claim, updating it promptly as new information is obtained.
Make timely, sound decisions on claims issues based on the best available information and in accordance with company standards, training, supervisory direction, and applicable laws; escalate issues and red flags to a supervisor or appropriate internal team.
Coordinate the actions of other professionals involved in claims, including attorneys, nurse case managers, and investigators, to achieve successful resolution.
Assign appropriate tasks to Claims Assistants or Claims Clerical Assistants and ensure they are performed correctly and efficiently.
Prepare accurate litigation referrals, AOE/COE investigation referrals, and MSA referrals for vendor submission, obtaining management approval.
Prepare timely and accurate settlement recommendations within designated authority parameters and negotiate claim settlements.
Maintain working relationships with partner-company staff, including the Call Center, Medical Management, Special Investigations, Client Services, Underwriting, and Claims Legal.
Communicate with clients, medical providers, and injured workers.
Collaborate with adjusting staff and relevant interdepartmental personnel on special projects focused on process efficiency.
Meet continuing education requirements.

Desired Qualifications

Self-Insured certification is a plus and is also identified as preferred.
High proficiency in Microsoft Excel is preferred.
Critical thinking, inquisitiveness, adaptability, and time-management skills.

Salary Range: 70304 to 95130 (Currency: USD) (Pay period: per-year-salary)

WHAT WE'RE LOOKING FOR

Berkshire Hathaway Homestate Companies has an immediate opportunity for an experienced workers compensation adjuster. We're looking for self-starters who can work under minimum direction, can achieve defined results, and are willing to accept ownership for their work product.

This Claims Professional is responsible for the management of a caseload of workers compensation indemnity claims from inception to resolution, performing initial investigation and compensability determination, reserve analysis and strategic planning, timely benefit administration to injured workers, and coordination of medical care and legal process, while maintaining the highest level of service to our insureds.

ESSENTIAL RESPONSIBILITIES

Conducts the investigation of reported claims via three-point contact calls to determine coverage, compensability and severity, and to gather all other relevant information, documenting all relevant information thoroughly and escalating the investigation for further investigation when appropriate.
Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
Calculates and administers benefits in accordance with statutory requirements, including timely issuance of appropriate notices and filings.
Develops and updates a Plan of Action for the successful resolution of each claim; timely updates Plan as new information is obtained.
Makes prompt, sound decisions on issues that arise in claims based on the best information available, ensuring that work is performed in accordance with Company standards, training, supervisory direction, and applicable laws. Timely escalates issues/red flags to Supervisor and/or appropriate internal team.
Ensures that the actions of all other professionals involved in claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.
Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently.
Accurately and thoroughly prepares litigation referrals, AOE/COE investigation referrals, and MSA referrals for submission to vendor; obtains proper approval from Management.
Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates settlement of claims.
Fosters a positive and close working relationship with partner company staff, including the Call Center, Medical Management, Special Investigations, Client Services, Underwriting, and Claims Legal.
Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers.
Collaborates with Adjusting staff and relevant interdepartmental personnel on special projects focused on process efficiency.
Ensures continual education requirements are met.

REQUIRED QUALIFICATIONS

EDUCATION: Minimum of a High School diploma required or equivalent certificate required; Bachelor's degree from four-year College or university preferred.
DESIGNATION: Designated as a Claims Adjuster or Experienced Claims Adjuster per the California Code of Regulations and has completed the minimum required continuing education credits to adjust workers compensation claims for the State of California; Self-Insured certification a plus.
EXPERIENCE: Minimum of three years of indemnity adjusting experience managing large and/or complex claims and accounts within a workers’ compensation carrier required
Maintains qualifying educational criteria to adjust workers’ compensation claims for the State of California; Self-Insured certification preferred.
Inquisitive, critical thinker; agile learner with adaptive, smart time management skills.
To perform this job successfully, an individual should be proficient in the Microsoft Office Suite of applications (highly proficient in Excel preferred), and be proficient on applicable databases, systems and vendor software programs.

WHAT WE OFFER

Work-Life Balance
Work From Home Program (up to 2 days per week)
Reasonable caseload with in-house Medical Management support (UR, Med Bill Review, Resource Nurses); In-house Claims Assistant support
Free On-Site Fitness Facility
Free On-Site Garage Parking
Paid Time Off
Paid Holidays
Retirements Savings Match
Group Health Insurance (Medical, Dental, and Vision)
Life and AD&D Insurance
Long Term Disability Insurance
Accident and Critical Illness Insurance
Flexible Savings Accounts
Paid Community Volunteer Day
Employee Assistance Program
Tuition Reimbursement Program
Employee Referral Program
Diversity, Equity and Inclusion Program

About the Company

Berkshire Hathaway

Diversified holding company across insurance, utilities

Berkshire Hathaway is a diversified holding company that owns and manages a portfolio of businesses across insurance, utilities, manufacturing, and retail. It generates revenue from the profits of its subsidiaries and from investment income from its large portfolio of stocks and bonds. Its operations include providing property and casualty insurance, operating utility companies, manufacturing goods, and owning retail brands such as Borsheim's Fine Jewelry. Its goal is to build long-term shareholder value by sustaining cash flow and value across a broad mix of high-quality companies and investments.

Company size: 11-50
Company stage: IPO
Headquarters: Omaha, NE
Founded: 1839

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