Berkshire Hathaway Homestate Companies - Workers Compensation Division

Claims Specialist

• Investigate assigned property damage and bodily injury claims reported under affiliated Companies' insurance contracts
• Identify information and documents needed to evaluate claims
• Assign and direct independent adjusters and review public and other records and documents
• Contact Insureds, Claimants and others regarding information, claim processes, resolution alternatives and related matters
• Comply with claims handling laws and regulations
• Engage defense counsel and monitor defense of Insureds at higher levels, or work with internal legal counsel
• Analyze and determine rights and obligations under applicable insurance contracts
• Coordinate with the Legal Department on coverage, compliance and legal issues
• Analyze, evaluate and estimate liability and losses
• Identify and report potential fraud to the Special Investigation Unit
• Use decision theory principles to evaluate claim settlement scenarios
• Establish and modify appropriate case reserves
• Review and approve or disapprove invoices for allocated loss adjustment expenses
• Maintain and review claim diaries and claim files
• Negotiate and resolve assigned claims within established authority or recommend resolution to management
• Prepare and maintain accurate records of communications and required claim documentation
• Maintain current knowledge of insurance and claim management principles through professional literature, opinions, periodicals and conferences

Senior Claims Examiner

Business Development Rep

• Assist with special assignments and projects as needed
• Create and execute territory plans with effective travel plans
• Position BHHC as the market of choice with agents and target markets
• Search for new agency appointments, prospect meetings, book transfer opportunities, and additional agency production sources
• Monitor agency growth and profitability and develop profit improvement and growth plans
• Manage agency partnerships, appointments, terminations, renewal strategy discussions, and agency production
• Conduct in-person agency visits and participate in prospect meetings, claims reviews, meet and greets, and stewardship meetings
• Coordinate strategic co-travel with Underwriting, Client Services, and Loss Control teams
• Educate agents on BHHC’s value proposition, target markets, acquisitions, territory goals, and service model
• Serve as a resource to peers and brokers; senior-level employees may mentor other Business Development Managers
• Participate in weekly underwriting meetings and support large-account discussions, quoting, and opportunity development
• Gather, analyze, and evaluate competitor information and territory opportunities
• Develop action plans using competitor intelligence and provide data for Agency Marketing Reviews
• Work with Marketing, Underwriting, and IT to improve templates, systems, product offerings, and ease of doing business
• Maintain accurate Producer Profiles, Business Plans, Agency Files, Bravo contacts, and business activity reports
• Maintain President’s Circle information for assigned agencies and leverage it for new business and renewals
• Serve on internal and external insurance committees, attend charity events and insurance conferences, and expand workers compensation and insurance expertise

Business Development Manager

• Creates and executes territory plans with effective travel plans.
• Positions BHHC as the market of choice with agents and target markets.
• Searches for new agency appointments, prospect meetings, book-transfer opportunities, and additional agency production sources.
• Monitors agency growth and profitability and develops profit improvement and growth plans.
• Manages agency partnerships, appointments, terminations, renewal strategy discussions, and growth goals.
• Conducts in-person agency visits and participates in prospect meetings, claims reviews, meet and greets, and stewardship meetings.
• Initiates strategic co-travel with Underwriting, Client Services, and Loss Control teams when appropriate.
• Educates agents on BHHC’s value proposition, target markets, acquisition opportunities, territory goals, and service model.
• Participates in weekly underwriting meetings and supports opportunities by industry, class code, and segment.
• Gathers and analyzes competitor information and territory opportunities and develops action plans using competitor intelligence.
• Provides input and data on Agency Marketing Reviews and shares information with peers and underwriting partners.
• Works with Marketing, Underwriting, and IT to improve templates, systems, product offerings, and business capabilities.
• Maintains Producer Profiles, Business Plans, Agency Files, Bravo contacts, and related reports.
• Maintains President’s Circle information and uses the program to support new business and renewals.

Senior Business Development Manager

• Successfully complete classroom training introducing workers compensation claims handling strategies, medical terminology, statutory requirements, and investigative skills
• Conduct initial investigation of reported claims to determine coverage, compensability, severity, and gather relevant information via three-point contact telephone calls
• Calculate appropriate reserves for each claim and adjust reserves as needed per authority guidelines
• Develop and update a Plan of Action for successful resolution of each claim
• Make prompt, sound decisions according to Company guidelines and applicable statutory requirements; escalate issues/red flags to Supervisor
• Ensure benefits due injured workers are calculated and issued appropriately, including required notices and filings
• Foster working relationships with internal and external partners, including Call Center, Medical Management, Special Investigations, and Indemnity Adjusting Staff
• Manage a caseload of workers compensation claims from inception to resolution after successful completion of the Claims Training program

Claims Adjuster – Trainee

• Complete classroom training introducing workers’ compensation claims handling strategies, medical terminology, and legal concepts
• Learn investigative and persuasive communication, negotiation, decision-making, and strategic planning skills
• Review and interpret medical records
• Conduct and direct investigations of reported claims to determine coverage, compensability, severity, and other relevant information
• Make three-point contact telephone calls
• Calculate appropriate reserves for each claim and adjust reserves as needed per authority guidelines
• Develop and update action plans for successful claim resolution
• Assign tasks to Claims Assistants and/or Claims Clerical Assistants and ensure efficient completion
• Reduce fraud through early identification and escalation
• Communicate with clients, medical providers, and injured workers
• Prepare timely and accurate settlement recommendations and negotiate claim settlements
• Coordinate attorneys, nurse case managers, investigators, and other professionals involved in claim management
• Manage a caseload of workers’ compensation claims from inception to resolution after successful completion of the Claims Training program

Claims Examiner – Trainee

• Complete classroom training introducing workers’ compensation claims handling strategies, medical terminology, and legal concepts
• Learn investigative and persuasive communication, negotiation, decision-making, and strategic planning skills
• Review and interpret medical records
• Conduct and direct investigations of reported claims to determine coverage, compensability, severity, and other relevant information
• Make three-point contact telephone calls
• Calculate appropriate reserves for each claim and adjust reserves as needed per authority guidelines
• Develop and update action plans for successful claim resolution
• Assign tasks to Claims Assistants and/or Claims Clerical Assistants and ensure their correct and efficient completion
• Reduce fraud through early identification and escalation
• Communicate with clients, medical providers, injured workers, and other external parties
• Prepare timely and accurate settlement recommendations within designated authority parameters
• Negotiate claim settlements
• Coordinate attorneys, nurse case managers, investigators, and other professionals involved in claim management
• Manage a caseload of workers’ compensation claims from inception to resolution after successful completion of the Claims Training program

• Successfully complete classroom training introducing workers compensation claims handling strategies, medical terminology, statutory requirements, and investigative skills
• Conduct initial investigation of reported claims to determine coverage, compensability, severity, and gather relevant information via three-point contact telephone calls
• Calculate appropriate reserves for each claim and adjust reserves as needed per authority guidelines
• Develop and update a Plan of Action for successful resolution of each claim
• Make prompt, sound decisions in accordance with Company guidelines and applicable statutory requirements
• Timely escalate issues and red flags to Supervisor
• Ensure benefits due injured workers are calculated and issued appropriately in accordance with legal requirements, including appropriate notices and filings
• Foster positive working relationships with internal and external partners, including Call Center, Medical Management, Special Investigations, and Indemnity Adjusting Staff
• Manage a caseload of workers compensation claims from inception to resolution
• Manage medical care, legal processes, and client relations