Medical Claims Specialist
NOTE: BHHC does not conduct interviews via social media (e.g. Google hangout, LinkedIn, etc.). Please be aware that any such contact is fraudulent and we advise that you not provide any personal information.
WHO WE ARE:
As a member of the Berkshire Hathaway group of insurance companies, we offer outstanding opportunities for professionals interested in working with a successful company. We offer unparalleled financial strength, stability and “large company” benefits, in addition to an exciting, friendly, “small company” atmosphere.
POSITION DESCRIPTION:
Berkshire Hathaway Homestate Companies has an opening in our Omaha, NE Office location for Medical Claims Specialist. The Medical Claims Specialist will successfully complete the Medical Claims Training Program, and will then successfully manage a caseload of workers’ compensation medical 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 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, client services, and the indemnity claims staff.
QUALIFICATIONS:
- Experience: Experience in the fields of law, medicine, insurance, workers compensation, telephonic communication, or negotiation is useful but not necessary.
- Education: HS Diploma or equivalent certificate, required.
- 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: Knowledge of Microsoft Office software. Able to quickly master proprietary and vended software applications.
COMPREHENSIVE BENEFITS PACKAGE:
- Health and wellness – low premiums for medical, dental and vision coverage; FSA and EAP benefits
- Company paid Life, Disability and AD&D benefits
- Employee Retirement Savings Plan with employer match up to 5% of compensation
- Generous Paid Time Off and Holidays
- Education Assistance Reimbursement
- Recognition and Rewards Programs
- Company Store
- Discounts across Berkshire Hathaway Inc. companies such as GEICO, See’s Candies, etc.
ABOUT US:
The Berkshire Hathaway Homestate Companies (BHHC) is a group of six insurance companies that are part of the Berkshire Hathaway Insurance Group. Our Workers Compensation Division provides premier workers compensation insurance coverage to employers across the country, with offices in San Francisco, San Diego, Sacramento, Pasadena, Omaha, Philadelphia, St. Louis, Atlanta, and Dallas.
As a member of the Berkshire Hathaway Insurance Group, BHHC has earned an enviable record of success in the insurance industry that is supported by an A++ A.M. Best rating for the last 10 consecutive years. Our corporate size enables our organization to react swiftly and effectively to opportunities in the insurance marketplace. At the same time, our financial strength provides our agents and insureds security and makes us one of the best brands in the marketplace.
We value each individual and recognize that attracting and retaining high quality talent is essential to the success of our company. Our structure minimizes bureaucracy and creates an environment that encourages our employees to see the direct effects of their hard work throughout the company. Each division provides hands on training and maintains a small company feel, creating an atmosphere in which 'team players' thrive.
Within the last six years BHHC Workers Compensation has seen significant growth, and we’re continuing to grow as we build one of the largest Workers Compensation companies in the country – join us!
This organization participates in E-Verify. For more information on E-Verify, please contact DHS: 888.897.7781 www.dhs.gov/E-Verify.
We will consider for employment qualified applicants with criminal histories as required by local ordinance. Additionally, no applicant will be denied employment solely on the grounds of conviction of a criminal offense except to the extent necessary to obtain a necessary license or to comply with The Violent Crime Control and Law Enforcement Act of l994, which prohibits the employment by an insurance company of persons convicted of certain crimes, unless a waiver is obtained.