Claims Supervisor

1 week ago

Omaha, United States biBERK Insurance Services Full time

The Workers' Compensation Claims Technical Services Supervisor will oversee teams providing claims process support and oversight of third-party administrators. This is intended to be a leadership position within the BHDIC Claims Department and requires extensive knowledge of workers' compensation claims handling processes, as well as regulatory requirements. The Supervisor will develop and lead a team of Technical Services Team Leads and TPA Liaisons. The position reports to the Workers' Compensation Claims Manager.

Job Responsibilities

  • Lead, mentor and develop a team of TPA Liaisons, responsible for oversight of Workers' Compensation claims, and WC Technical Services Team Leads, overseeing EDI and bill review functions within the Workers' Compensation department
  • Set priorities for EDI, Repricing, and TPA Oversight teams to ensure task completion and performance goals are met
  • Serve as a subject matter expert; participate in internal and external projects
  • Consolidate regulatory fines and appeal process and ensure tracking of data; longer term goal will be to reduce WC claims fines
  • Assist WC Claims Manager in staffing and group structural decisions as team grows rapidly
  • Develop and maintain strong relationships with cross-functional teams and vendor partners to improve product and service quality
  • Provide technical support and guidance to internal team, troubleshooting complex issues as needed
  • Prepare and present reports and updates to Claims leadership, highlighting project status and recommendations for improvement
  • Identify, implement and manage process enhancements to improve overall team delivery of EDI, bill review, and TPA Oversight teams
  • Partner with Claims leadership to determine best practices and promote teamwork
  • Analyze organizational needs; recommend changes or updates to staffing
  • Report account changes or vendor problems to ensure vendors meet service level agreement expectations
  • Ensure quality performance of medical bill repricing, state filing, and TPA program through monitoring of quality outcomes
  • Partner with internal resources to direct the management of vendor performance
  • Identify process gaps and implement process improvements
  • Accountable for coaching, regular 1:1's, team meetings, feedback conversations, and bi-annual performance reviews
  • Additional projects and duties as assigned
TPA Oversight- WC Claims
  • Collaborate with WC Claims Manager and TPA Liaison team to design and implement TPA oversight process focused on delivering superior claims handling of TPA handled Workers' Compensation claims nationwide
  • Provide technical expertise and oversight to a team of Workers' Compensation TPA Oversight Liaisons, ensuring the quality of services provided by TPA meet internal best practices. This is accomplished by regular file reviews and audits to ensure proper claim strategy/reserving/litigation management, granting reserve and settlement authority on cases that exceed TPA or team authority, and ensuring proper use of approved WC vendors and legal partners
  • Attend weekly TPA client meetings to ensure all TPA program requirements are met
  • Participate in settlement discussions with Claims leadership on high exposure WC claims managed by TPA
  • Identify TPA claims requiring additional discussion to align on strategy/reserves and attend bi-annual claim reviews
EDI & Medical Bill Repricing
  • Oversee the implementation and maintenance of EDI and repricing systems, ensuring seamless data interchange with business partners and ongoing performance metrics are met
  • Develop, measure and coach to performance goals and measurements
  • As the team rapidly grows, collaborate with WC Manager on determining team organization structure, role expectations, and processes
  • Partner with team leads to ensure EDI and repricing processes are followed in accordance with established guidelines and state requirements
  • Track and review EDI and repricing data, such as fines, response timeframes, etc, and create a culture of continuous improvement
  • Stay abreast of WC EDI reporting requirements and updates and ensure systems/processes are updated accordingly
  • Engage medical management vendor for support with EDI/repricing and oversee those functions
Qualifications
  • Prior experience adjusting workers' compensation claims (multi-jurisdictional knowledge a plus)
  • Prior personnel management experience
  • Prior experience with regulatory compliance related to workers' compensation insurance
  • Strong verbal and writing/editing skills
  • Proficiency in understanding metrics that impact overall department objectives
  • Four-year college degree required
  • Strong leadership, management, and motivational skills
  • Computer proficiency and technical aptitude, including the ability to utilize MS Office products, Slack, Teams, and Outlook
  • Strong analytical, organizational, multitasking, and time management skills
  • Active Adjuster license or willingness to obtain a license within 90 days
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:
  • Work/Life balance - no nights or weekends
  • Great work environment with growth opportunity
  • Subsidized downtown parking
  • Competitive compensation
  • Generous amounts of vacation and sick time
  • Closed on major holidays
  • 401(k) with company match
  • Service recognition awards after 5 years of employment
  • A fantastic healthcare package
  • Tuition reimbursement after 6 months of employment
  • Be part of Berkshire Hathaway Inc., one of the world's most admired companies


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 $100,000 to $120,000 per year. Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.

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