Complex Workers' Compensation Claims Specialist (Northeastern USA)

h3Job Type /h3 pFull-time /p h3Description /h3 pBerkshire Hathaway Direct Insurance Company (BHDIC) is the home of commercial small business insurance products biBerk Business Insurance and THREE by Berkshire Hathaway. Our Claims Department is looking for an experienced claims specialist with a strong background in complex Workers’ Compensation claims. This role handles a caseload of highly complex/high-severity Workers’ Compensation claims and requires a comprehensive knowledge of Workers’ compensation regulations, laws, and best practices. This role will report to the Workers’ Compensation Complex Claims Team Lead. Multi-state experience handling Workers’ Compensation claims in the following jurisdictions are preferred: CT, DE, MI, NH, RI , VA, MA, PA, MN and WV. /p h3Location /h3 pLocation: This is a full-time remote position. This position may require occasional travel to attend mediations, trainings, and/or other related department meetings. /p h3Job Responsibilities /h3 ul liInvestigate coverage, determine compensability, and manage a pending of high exposure Workers’ Compensation claims involving catastrophic injuries and complex cases /li liProactively establish and update reserves throughout the life of the claim to reflect claim exposure and document supporting rationale /li liResolve claims within authority and make independent case value recommendations to senior leadership on cases which exceed authority /li liParticipate in reserving, pricing and strategy discussions with senior leadership /li liCollaborate with outside defense counsel to effectively manage litigated files according to established litigation management guidelines /li liPartner with medical providers, customers, and injured workers to facilitate appropriate medical treatment and ensure timely submission of medical bills /li liEnsure compliance with state and federal Workers’ Compensation regulations /li liProvide exceptional customer service to policyholders, agents, injured workers, medical providers, legal, and vendors /li liFollow escalation and reporting requirements on claims with significant exposure /li liDevelop creative resolution strategies to manage losses involving complex issues, effectively utilizing appropriate internal and external resources /li liDocument claim files in accordance with company and regulatory guidelines /li liIdentify subrogation potential and red flags that require SIU involvement /li liTrain new team members /li liAct as a technical resource to less experienced claims representatives /li liMaintain continuing education requirements /li /ul h3Knowledge And Experience /h3 ul liActive adjuster license required /li li10+ years of experience handling complex workers’ compensation claims /li liExcellent organizational, leadership, communication and time management skills /li liExperience with structured settlements and Medicare Set-Asides /li liAbility to work in a fast-paced, collaborative, virtual office environment /li liStrong analytical, organizational, and time management skills /li liExcellent written and verbal communication skills /li liAbility to work independently and meet assigned deadlines /li liStrong negotiation skills /li liAbility to multi-task and effectively prioritize tasks with frequent interruptions /li liProficiency with MS Word, Excel and internet applications /li liHighly attentive to details /li liAble to work under pressure and execute good judgment in sensitive situations /li liAdvanced verbal and written communication skills are essential for interacting with internal and external stakeholders /li /ul h3Education /h3 ul liBA/BS degree required /li liAIC, SCLA, CPCU or other industry designation a plus /li /ul h3About Us /h3 pbiBerk 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. /p pBHDIC 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. /p pBHDIC is excited to announce our comprehensive benefits package with some new and enhanced features for 2026 that include: /p ul liMedical (PPO/HDHP), vision, disability, and life insurance. /li liEnhanced dental plan with orthodontia coverage in addition to a standard plan. /li liGenerous PTO plan for all benefit-time eligible employees. /li liPaid company holidays and 4 floating holidays. /li liPaid parental leave. /li liEmployee Retirement Savings Plan/401(k) with company match and immediate vesting. /li liEducation Assistance Program that offers 100% upfront tuition reimbursement after 6 months of service for approved degree programs. /li liService Recognition Program that provides a monetary award to be used toward a vacation every 5 years of employment. /li liWellness Initiatives that include Fitness Center and Weight Watchers Reimbursement programs. /li liVoluntary benefits that include accident, critical illness, and hospital indemnity. /li liEmployee discount and rewards program on travel, tickets, electronics, home, and more. /li /ul pIn accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided. The salary range for this position is b$95,000 - $115,000 per year. /b Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law. /p #J-18808-Ljbffr