Berkshire Hathaway Homestate Companies - Workers Compensation Division

Claims Specialist

• Successfully completes classroom training introducing workers compensation claims handling strategies, medical terminology, statutory requirements, and investigative skills.
• Conducts initial investigation of reported claims to determine coverage, compensability, severity, and gather all other relevant information via three-point contact telephone calls.
• Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
• Develops and updates a Plan of Action for the successful resolution of each claim.
• Makes prompt, sound decisions on issues that arise based on the best information available, ensuring that work is performed in accordance with Company guidelines and applicable statutory requirements. Timely escalates issues/red flags to Supervisor.
• Ensures benefits due injured worker are calculated and issued appropriately in accordance with legal requirements including the issuance of appropriate notices and filings.
• Fosters a positive and close working relationship with internal and external partners, including Call Center, Medical Management, Special Investigations, and Indemnity Adjusting Staff.

Claims Adjuster

• Completes classroom training introducing workers’ compensation claims handling strategies, medical terminology, and legal concepts.
• Learns skills such as investigative and persuasive communication, negotiation, decision-making, and strategic planning. Learns to review and interpret medical records.
• Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls.
• Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
• Develops and updates a plan of action for the successful resolution of each claim.
• Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently.
• Reduces fraud through early identification and escalation.
• Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers.
• Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
• Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.

Claims Examiner – Trainee

• Helps injured workers achieve rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support.
• Effectively communicates with injured workers and employers. Demonstrates expertise and empathy, building trust and moving the claim forward, including timely three-point contacts on all new losses.
• Manages claims with an outcome-based and resolution focus. Demonstrates highly effective strategic plans for future handling that are well outlined in plans of action and followed through in a timely fashion.
• Demonstrates effective decision making in compensability determinations and benefit authorizations (within designated authority parameters). Proactively utilizes resources such as Medical Management, SIU, Subrogation, Recovery and Legal to ensure accurate determinations in compensability, causal relationship, appropriate medical treatment, and to achieve favorable outcomes.
• Prepares and maintains timely, accurate reserves on all claims for expected future costs of medical treatment, benefits and other elements in accordance with Claims Handling Guidelines. Ensures reserves are escalated and approved as appropriate. Ensures there is appropriate reserve documentation in the file.
• Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
• Reduces fraud through early identification and escalation.
• Effectively manages defense attorneys. Demonstrates excellence in litigation management by being prepared for hearings in a timely manner and appropriately considering exposures, settlement options, and other legal issues.
• Reviews and approves vocational rehabilitation plans.
• Effectively manages vendors and providers. Identifies need for assignment and removal of vendors and makes effective use of vendor expertise while maintaining ownership of the claim.
• Demonstrates expertise in technical aspects of claim management. Works with Medicare Set Asides, Structured Settlements and/or Part B issues.
• Maintains effective relationships with internal and external service partners, including participation in periodic telephonic claims reviews.
• Calculates and pays benefits in accordance with the law. Ensures that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings.

Senior Claims Adjuster – Workers Compensation

Threat Intelligence Specialist

• Perform data mining of internal systems to detect claims and billing patterns relevant to specific investigations. Collect and organize data for timely submission to regulatory and law enforcement authorities.
• Conduct research using publicly available and subscription-based databases; maximize the utilization of web-based resources to advance investigations.
• Prepare charts, spreadsheets, and other visual aids for presentations to management, counsel, and law enforcement. Create and modify reports/queries on SIU activities.
• Identify and analyze questionable patterns and other red flags (Claims, Premium, or Provider) in order to identify documents for further review by an investigator.
• Foster a positive working relationship and regular communications between the SIU and other departments, primarily Claims, Client Services, Premium Audit, Medical Management/Bill Review, and Data Analytics.

Background and Data Intelligence Analyst

General Counsel

• Join in-house legal department to handle workers' compensation defense.
• Understand and apply California workers' compensation law.
• Engage in communication, negotiation, and litigation activities.
• Conduct trials and depositions as needed.

Workers' Compensation Defense Attorney – House Counsel

• Join in-house legal department at Berkshire Hathaway Homestate Companies.
• Represent clients in workers' compensation defense cases.
• Utilize excellent communication, negotiation, deposition, and litigation skills.

Senior Workers Compensation Defense Attorney

• Berkshire Hathaway Homestate Companies, Workers Compensation Division, is seeking an experienced workers' compensation defense attorney to join its in-house legal department.
• The ideal candidate will have a solid understanding of California workers' compensation law.
• Excellent communication, negotiation, deposition and litigation skills.
• Recent trial experience.

Workers' Compensation Defense Attorney – Associate House Counsel

• Investigate, evaluate, provide defense if appropriate, negotiate and resolve assigned property damage and bodily injury claims
• Identify information and documents needed to evaluate claims
• Contact Insureds, Claimants and others regarding information necessary to evaluate and resolve claims
• Comply with claims handling laws and regulations
• Analyze, evaluate, and estimate liability of Insureds and loss of Claimants/Insureds for assigned claims
• Establish and timely modify appropriate case reserve reflecting available information
• Negotiate and resolve assigned claims within established authority

Senior Claims Examiner

Director

• Review rate adequacy and provide recommendations when deviations and revisions from standard assumptions are appropriate.
• Enhance and refine existing pricing models and develop new pricing models to support the Company’s strategic objectives.
• Monitor legislative and regulatory activity and ensure compliance in mandated reporting.
• Develop and maintain analytical standards and procedures, including peer reviews, to ensure consistency across department of analysis, execution, knowledge sharing and documentation.
• Actively engage with and participate in industry professional organizations and rating committees, representing the Company’s strategic interests while presenting as an expert thought leader within the professional community.

Director of Pricing

• Manages and directs the work of the reserving team (e.g., Actuaries, Analysts), including keeping everyone on task to complete recurring assignments within tight timeframes.
• Turns data into critical information and knowledge that can be utilized to determine organizational decisions. Presents findings to Senior Leadership.
• Selects actuarial assumptions and methods based on all available sources of data, reviews alternative assumptions, and is prepared to explain and defend assumptions upon review by peers, senior leaders, and non-actuaries.
• Develops and maintains analytical standards and procedures, including peer reviews, to ensure consistency of analysis, execution, knowledge sharing, and documentation.
• Monitors legislative and regulatory activity. Incorporates the effects of benefit and rate changes into actuarial analyses.
• Actively engages with and participates in industry professional organizations and rating committees, representing the company's strategic interests while presenting as an expert thought leader within the professional community.
• Prepares and presents ad-hoc research and reporting.

Berkshire Hathaway Homestate Companies - Workers Compensation Division

Claims Adjuster

Claims Examiner – Trainee

Senior Claims Adjuster – Workers Compensation

Background and Data Intelligence Analyst

Workers' Compensation Defense Attorney – House Counsel

Senior Workers Compensation Defense Attorney

Workers' Compensation Defense Attorney – Associate House Counsel

Senior Claims Examiner

Director of Pricing

Director of Pricing

Director of Pricing

Director of Pricing

Director of Pricing

Director of Reserving

Director of Reserving