Claims Assistant 1

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening for a Claims Assistant in its San Diego office! This individual works in tangent with Claims Professionals to ensure administration of benefits due injured workers is timely and accurate, demonstrating ability to apply regulations governing administration process and Company guidelines, and escalating issues, approval needs, and questions timely to management.

ESSENTIAL RESPONSIBILITIES

Reviews and prioritizes daily diary instructions from Claims Professional and/or Supervisor, ensuring appropriate urgency is given to time sensitive tasks (e.g., payments, regulatory notices), and promptly notifying of any impediment to task completion. Communicates with Claims Professional and/or Supervisor to clarify and rectify discrepancies and/or obtain proper approval prior to completion.

Accurately assesses benefit eligibility pursuant to State regulatory guidelines. Issues correlating payments and benefit notices timely, including amended notices when applicable. Issues compensability notices timely adhering to State regulatory guidelines and company protocols.

Generates new claim set up notifications/correspondence for incoming claims and for those claims identified for transfer from the Medical Claims Specialist Unit to Indemnity Unit. Secures wage information needed timely upon identification of need for transfer.

Assists with scheduling medical evaluations as needed. Routinely updates on disability status post-appointment.

Appropriately schedules and manages use of vendors when necessary for transportation, translation, and subpoena services.

Coordinates service of required documentation to appropriate parties on litigated claims: Prepares index of documentation. Assists with cover letter as necessary. Ensures appropriate documentation is included in package and any necessary redaction is completed. Verifies service completion.

Timely submits necessary internal service requests with required documentation to appropriate department for handling: Check pull/voids, stale-dated, and stop payment requests. Reissuance of medical payment (Medical Bill Review). Non-Medical Bill Review payment requests (legal billing and non-medical vendor requests). Return-To-Work referrals. W-9 coordination for payment requests.

Timely and concisely notes updates upon completion of tasks within the Claims Tracking System. Appropriately escalates issues/red flags to Claims Professional and/or Supervisor.

Completes other ancillary services as needed, including coverage of Reception desk.

QUALIFICATION

EDUCATION: High School Diploma or HS Equivalency credential required.

TECHNICAL SKILLS: Ability to read and interpret documents such as medical reports, legal documentation (settlement documentation), and State regulatory guidelines governing workers compensation. Ability to write routine correspondence. Knowledge of Microsoft Office 365 applications (e.g., Word, Excel) and be proficient on applicable databases, systems, and vendor software programs. Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

NEEDED COMPETENCIES

Time Management/Sense of Urgency

Attention to detail

Service oriented

Able to manage multiple priorities effectively

Sound communicator

Excels in the spirit of collaboration

WHAT WE OFFER

Modern Office Setting

Free On-Site Fitness Facility

Free On-Site Garage Parking

Paid Time Off

Paid Holidays

Immediate Vesting of Retirement Savings + Company Match

Group Health Insurance (Medical, Dental, and Vision)

Life and AD&D Insurance

Long Term Disability Insurance

Hospital Indemnity 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