Claims Coverage Specialist - Workers' Compensation

The Coverage Specialist will collaborate with legal to evaluate and manage a nationwide inventory of litigated and non-litigated Workers’ Compensation no coverage matters.  This is a highly visible role that will serve as a company representative at Workers’ Compensation mediations and proceedings for no coverage matters. This is a leadership position involving oversight of claims technicians handling non-litigated coverage inquiries and providing administrative support to the WC Coverage team. This position will report to the Workers’ Compensation Claims Manager.

Location: This is a full-time remote position, but may require occasional travel to attend trainings, department meetings, mediation or hearings.

Job Responsibilities

The Coverage Specialist will be responsible for, but not limited to:

• Investigate, manage and resolve claims reported under Company insurance policies within established authority and as required by applicable law, with a focus on coverage vs. no coverage decisions
• Clearly communicate no coverage decisions to insureds and other applicable third parties by thoroughly explaining the rationale behind the no coverage decision and addressing questions or concerns
• Assign counsel and provide direction on recommended legal strategy
• Independently identify and meet deadlines on litigated matters, including confirmation that the Company has been appropriately released from the litigation
• Negotiate and resolve Workers’ Compensation no coverage matters within documented authority
• Prepare accurate and timely case summaries, evaluations and reports
• Evaluate, settle and/or manage the defense of no coverage litigation, including selection and oversight of outside counsel, and control of loss adjustment expenses within established authority
• Testify on behalf of the Company regarding coverage denials as required on a case-by-case basis
• Draft and file state-required documentation of no coverage decisions/denials and follow up, as needed, with applicable State Boards/WC tribunals to ensure the Company is timely released due to no coverage.  The Coverage Specialist must have knowledge of various state filing requirements for no coverage denials and FROI filings.
• Monitor, along with the Coverage Claims Technician, incoming communications to evaluate for coverage decisions and ensure all Company processes are followed in terms of responsive documents, approving outside defense counsel as needed, and filing appropriate state filings
• Periodic travel to represent Company in settlement conferences and other proceedings, though most proceedings are virtual
• Coach and directly supervise the Claims Technician position
• Collaborate with external bill review vendor on WC no coverage litigation expense audit process
• Additional projects and duties as assigned

Qualifications

We are seeking candidates with the following:

• BA/BS degree required
• Active Adjuster license
• AIC, SCLA, CPCU or other industry designation preferred
• 5+ years of prior Workers’ Compensation claims experience, including a heavy litigated caseload
• Multi-state jurisdictional experience a plus
• Experience in determination of coverage vs. no coverage in regard to workers’ compensation reported claims
• Interpretation and application of insurance contracts, insurance claim procedures, loss evaluation methods and claim resolution alternatives
• Ability to work both independently and collaboratively within a virtual office environment
• Excellent oral and written communication with internal and external stakeholders
• Ability to independently work within deadlines and state law requirements
• Strong analytical, organizational, multitasking, and time management skills
• Computer proficiency and technical aptitude, including the ability to utilize MS Office products, Slack, Teams, and Outlook
• Strong investigation and negotiation skills
• Ability to independently analyze data, apply knowledge and logic, and draw conclusions
• Strong customer service skills
• Must have reliable internet
• Previous supervisory experience a plus
• Highly attentive to details
• Self-motivator: works independently with minimal supervision

About Us

biBerk is where commercial insurance buyers can obtain coverage for their businesses from insurers of the Berkshire Hathaway group of Insurance Companies, one of the best capitalized insurance groups in the world. Our ultimate parent, Berkshire Hathaway Inc. (berkshirehathaway.com) is a holding company with diversified interests in a host of industries, including insurance, energy, transportation and manufacturing. Most policies issued through biBerk.com will be underwritten by Berkshire Hathaway Direct Insurance Company ("BHDIC"), which is an AM Best rated A++ insurer.

BHDIC is domiciled in Omaha, Nebraska. BHDIC and the team at biBerk are focused on helping small business owners quickly and easily buy affordable insurance directly from a financially strong insurance company they can trust.

Some highlights of our benefits are:

• Great work environment with growth opportunity
• Subsidized downtown parking (for in-office positions)
• Competitive compensation
• Generous amounts of vacation and sick time
• Closed on major holidays
• 401(k) with company match
• A fantastic healthcare package
• Tuition reimbursement after 6 months of employment
• Service recognition after 5 years of employment

In accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided.  The salary range for this position is $90,000 to $112,000 per year.  Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.