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    Medical Claims Specialist - San Diego, United States - Berkshire Hathaway Homestate Company group

    Berkshire Hathaway Homestate Company group
    Berkshire Hathaway Homestate Company group San Diego, United States

    2 weeks ago

    Default job background
    Description
    Medical Claims Specialist - Workers Compensation

    Berkshire Hathaway Homestate Companies has an opening in our San Diego, CA office for a Medical Claims Specialist.

    After successful completion of the Medical Claims Training Program, this individual will manage a caseload of workers' compensation medical-only claims from inception to resolution.


    ESSENTIAL RESPONSIBILITIES
    Successfully completes the Medical Claims Training Program.

    In classroom training, is attentive, takes notes, asks appropriate questions, participates successfully in exercises, and demonstrates mastery of the subject material.

    In the Medical Claims 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 the injury, and diagnostic and treatment methodology.
    Learns legal subjects including relevant statutes and regulations.
    Learns to effectively and efficiently use the computer systems employed in the management of claims.
    Learns skills such as investigative and persuasive communication, decision-making, and documentation.

    For clients who are provided with a dedicated Claims Medical Specialist, establishes and maintains a sound working and communication relationship with the client's contact personnel.

    Determines coverage for new claims.

    Conducts and directs the investigation of new claims to determine compensability and severity and to gather all other relevant information.

    Calculates appropriate reserves and ensures that reserves are adjusted as needed.

    Ensures that 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.

    Manages each claim to an appropriate and successful resolution.
    Ensures that work is performed in accordance with Company procedures, standards, training, and supervisory direction.

    Fosters a positive and close working relationship with other Company staff, including the Call Center, Medical Management teams, Client Services, and indemnity Adjusting staff.


    REQUIRED QUALIFICATIONS

    EDUCATION:
    Minimum of High School Diploma or equivalent certificate required.


    EXPERIENCE:

    Administrative experience in the areas of law, medicine, insurance/workers compensation, telephonic communication, or negotiation is useful but not necessary.


    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:
    Able to effectively use Microsoft Office Suite applications. Able to quickly master proprietary and vended software applications.

    WHAT WE OFFER
    Manageable Caseloads
    Work-Life Balance
    Work From Home Program (up to 2 days per week)
    Free On-Site Fitness Facility
    Free On-Site Garage Parking

    BENEFITS
    Paid Time Off
    Paid Holidays
    Retirements Savings Match
    Group Health Insurance (Medical, Dental, and Vision)
    Life and AD&D Insurance
    Long Term Disability Insurance
    Paid Community Volunteer Day
    Employee Assistance Program
    Tuition Reimbursement Program
    Employee Referral Program
    Diversity, Equity and Inclusion Program

    ABOUT US


    With more than 50 years in business, BHHC has grown from a regional organization to a national insurance group, offering insurance products from coast to coast.

    Relationships are the cornerstone of our culture, and we believe in doing the right thing.

    That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success.

    Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts.

    At BHHC we embrace diversity and foster an environment where our people can be their authentic selves. Our differences make us stronger and better together, which fosters a harmonious workplace—something we truly value. We've created an approachable and collaborative atmosphere. Here you'll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work. Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.

    DISCLAIMERS
    This job posting is not intended as an exhaustive listing of responsibilities and qualifications. A copy of the job description is available upon request. The Work from Home Program is subject to certain eligibility requirements.

    #J-18808-Ljbffr
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