Berkshire Hathaway is a holding company run by Warren Buffett that owns a diverse range of private businesses and significant minority interests in public companies such as Apple. It has a market capitalization of over $715 billion and is the sixth-largest public company in the world.
Medical Claims Specialist – Workers Compensation
WHAT WE’RE LOOKING FOR
Berkshire Hathaway Homestate Companies has an opening in our San Diego, CA office for a Medical Claims Specialist. After successful completion of the Medical Claims Training Program, this individual will manage a caseload of workers’ compensation medical-only 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 the 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 teams, Client Services, and indemnity Adjusting staff.
REQUIRED QUALIFICATIONS
-
- EDUCATION: Minimum of High School Diploma or equivalent certificate required.
- EXPERIENCE: Administrative experience in the areas of law, medicine, insurance/workers compensation, telephonic communication, or negotiation is useful but not necessary.
- 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: Able to effectively use Microsoft Office Suite applications. Able to quickly master proprietary and vended software applications.
WHAT WE OFFER
-
- Manageable Caseloads
- Work-Life Balance
- Work From Home Program (up to 2 days per week)
- Free On-Site Fitness Facility
- Free On-Site Garage Parking
BENEFITS
-
- Paid Time Off
- Paid Holidays
- Retirements Savings Match
- Group Health Insurance (Medical, Dental, and Vision)
- Life and AD&D Insurance
- Long Term Disability Insurance
- Paid Community Volunteer Day
- Employee Assistance Program
- Tuition Reimbursement Program
- Employee Referral Program
- Diversity, Equity and Inclusion Program
In accordance with the California Equal Pay Act, the starting hourly wage for this job is $25.00. This hourly wage is what the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The pay scale applies only to this position and only if it is filled in California. The pay scale may be different for other positions or in other locations.
ABOUT US
With more than 50 years in business, BHHC has grown from a regional organization to a national insurance group, offering insurance products from coast to coast. Relationships are the cornerstone of our culture, and we believe in doing the right thing. That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success. Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts.
At BHHC we embrace diversity and foster an environment where our people can be their authentic selves. Our differences make us stronger and better together, which fosters a harmonious workplace—something we truly value. We’ve created an approachable and collaborative atmosphere. Here you’ll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work. Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.
DISCLAIMERS
This job posting is not intended as an exhaustive listing of responsibilities and qualifications. A copy of the job description is available upon request. The Work from Home Program is subject to certain eligibility requirements.
Workers Compensation Lien Claims Professional
WHAT WE’RE LOOKING FOR
Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a Lien Claims Professional to join our San Diego team! This adjusting professional will manage a caseload of settling/settled claims requiring lien resolution, negotiating optimal outcomes within authority parameters to achieve closure while managing cost-containment, and is always service-centric with internal and external partners. Sound like YOU?
ESSENTIAL RESPPONSIBILITIES
-
- Thoroughly reviews assigned claim files and provides detailed summary of lien exposure, vendor involvement, and potential issues. Creates a resolution-focused plan of action, sets appropriate diaries, and calculates appropriate reserves. Updates strategy and reserves as information becomes available within authority parameters. Seeks additional authority timely as needed.
-  Analyzes vendor billing in each claim file and identifies discrepancies or misalignment with claim documentation. Proactively makes inquiries to obtain information needed for actionable use.
-  Makes prompt, sound decisions on lien issues and offers that arise and documents thoroughly in claims file. Collaborates routinely with defense counsel, Adjusting, Medical Management, and SIU teams on lien issues. Ensures clear, timely communications to all parties on outstanding issues. Ensures actions are coordinated amongst relevant parties to achieve optimal resolution outcome.
- Â Recommends lien settlements, responds to lien demands at appropriate time and value and effectively negotiates settlement with vendor/provider or refers to defense counsel to adjudicate.
- Â Ensures that caseload is managed in compliance with applicable statutes, regulations, case law, and company standards.
- Follows guidance to optimize outcomes and to ensure claims are appropriately and timely addressed.
REQUIRED QUALIFICATIONS
-
-
- EDUCATION: Minimum of High School diploma or equivalent certificate required. Bachelor’s degree from an accredited four-year university preferred.
- EXPERIENCE: Minimum of three years of workers compensation indemnity claims adjusting experience, or an equivalent combination of education and industry experience, required.
- CERTIFICATIONS: Maintains qualifying educational criteria for State of California to manage a caseload of workers compensation claims. Self-Insurance Administrators Certification preferred.
- TECHNICAL AND COMPUTER SKILLS: (1) Strong California workers compensation indemnity claims management knowledge; (2) Moderate data analytic skills to perform solid data collection, analysis, and reporting; (3) Proficiency in Microsoft Office/365 suite of applications; (4) Knowledge of claims software systems and able to become proficient in proprietary and vendor software programs.
-
WHAT WE OFFER
-
- Manageable Caseloads
- Work-Life Balance
- Work From Home Program (up to 2 days per week)
- Modern Office Setting
- Free On-Site Fitness Facility
- Free On-Site Garage Parking
BENEFITS
-
- Paid Time Off
- Paid Holidays
- Retirements Savings Match
- Group Health Insurance (Medical, Dental, and Vision)
- Life and AD&D Insurance
- Long Term Disability Insurance
- Accident and Critical Illness Insurance
- Flexible Savings Accounts
- Paid Community Volunteer Day
- Employee Assistance Program
- Tuition Reimbursement Program
- Employee Referral Program
- Diversity, Equity and Inclusion Program
$66,560 – $85,150 a year
Claims Business Analyst Leader – Financial Transactions
Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an immediate opening for a Claims Business Analyst Leader to focus on financial transactions. This key change agent focuses on the organization’s Claims journey of continuous improvement, leading transformation initiatives aimed at optimizing financial transaction processes in the Claims lifecycle (payments, reserving, recoveries, and financial reporting), aimed at streamlining workflows to enhance accuracy, speed, and compliance in all financial-related aspects of Claims.
This leader will leverage market research and their expertise in process improvement methodology to design, prioritize, and execute strategic priorities to deliver operational efficiencies for the department, focusing on analytics, technology, and incorporation of best practices to develop project plans, timelines, and budgets, setting milestones and KPIs to monitor and report progress.
ESSENTIAL RESPONSIBILITIES
STRATEGIC LEADERSHIP
-
- Leads transformation projects from concept through implementation, utilizing market research and collaborative feedback with key stakeholders to design and implement operational improvements.
- Develops and manages project plans, timelines, and budgets, ensuring alignment with organizational objectives.
- Defines clear project milestones and KPIs to monitor progress and report to Senior Leadership.
- Collaborates with IT, Compliance, Learning & Development, and operational teams to ensure alignment and successful integration of transformation initiatives.
- Ensures seamless handover of new processes and solutions to the operational team for sustainable execution.
BUSINESS ANALYSIS
-
- Conducts in-depth analysis of current systems, workflows, and performance metrics to identify inefficiencies, gaps, and opportunities for improvement.
- Targets and transforms highly manual operational teams/processes toward automation.
- Prioritizes specific improvements that will yield greatest impact/ROI.
- Gathers and documents business requirements, engaging relevant stakeholders within Claims department and development teams.
- Develops vision and actively promotes business case for proposed changes, including cost/benefit analysis for presentation to Exec.
- Collaborates with development and design partners across company on time parameters, successful scope definition, and deployment.
- Solicits and integrates feedback from stakeholders/SME’s and leadership; develops effective feedback loops.
- Tracks performance throughout the duration of projects to ensure timely outcomes and alignment with business goals. Takes necessary steps to address or escalate deviations/issues and works collaboratively to find solutions.
CHANGE MANAGEMENT
-
- Acts as a change agent to foster a culture of continuous improvement within the Claims team.
- Develops and executes comprehensive change management strategies to ensure adoption of new processes.
- Ensures all impacted staff are thoroughly informed, receptive to changes, and appropriately trained.
STAKEHOLDER ENGAGEMENT
-
- Serves as the primary point of contact for all transformation-related communications.
- Ensures alignment of proprieties with key stakeholders and external vendors to ensure successful outcomes.
- Partners with Finance to ensure all initiatives provide adequate financial quality and segregation of controls and that audit requirements are met.
- Facilitates EDI compliance and accuracy along with the Compliance teams to ensure all initiatives meet regulatory and EDI requirements.
- Fosters a collaborative team environment by clearly communicating goals, progress and challenges to all relevant parties.
QUALIFICATIONS
-
- Education: Bachelor’s degree in Business Administration, Project Management, or related field. Masters degree preferred.
- Certifications: One or multiple preferred: Certified Project Manager (CPM), Project Management Professional (PMP), PMI Professional in Business Analysis (PMI-PBA).
- Experience: A minimum of 10 years of experience in business analysis, project management, or operational leadership, preferably within insurance or claims, required. Proven track record of leading large-scale transformation initiatives required. Experience with Lean, Six Sigma, or other process improvement methodologies a plus.
- Technical and Computer Skills:Â Excellent business acumen and understanding of workers compensation, project management, and business analytics. Advanced skills to perform data collection and reporting. Advanced knowledge of Microsoft Office applications and proprietary software. Strives to continuously build knowledge base and technical skills.
SKILLS NEEDED FOR SUCCESS
-
- Analytical Thinking
- Strategic Vision
- Problem-Solving
- Change Management
- Cross-Functional Leadership
- Process Improvement
- Stakeholder Engagement
COMPANY BENEFITS
-
- Work From Home (up to 2 days per week after eligibility)
- Bonus Eligible
- Paid Time Off
- Paid Holidays
- Retirements Savings Match
- Group Health Insurance (Medical, Dental, and Vision)
- Life and AD&D Insurance
- Long Term Disability Insurance
- Paid Community Volunteer Day
- Employee Assistance Program
- Tuition Reimbursement Program
- Employee Referral Program
- Diversity, Equity and Inclusion Program
Operations Command Center Engineer (OCCE2)
Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an immediate opening for an Operations Command Center Engineer 2 (OCCE2). The OCCE2 will be responsible for handling escalated incidents as referred by OCCE1, performing deeper troubleshooting, incident management, and root cause analysis. This individual will provide technical expertise to ensure uptime and efficiency in the operations of IT systems, applications, and infrastructure, and will be involved in maintaining and updating monitoring tools, processes, and cloud-based solutions to enhance operational efficiency. Contributes to key areas such as network management, system administration, and automation.
KEY RESPONSIBILITIES
-
- Manages escalated tickets from OCCE1 for advanced troubleshooting and problem resolution across network, system, and cloud platforms.
- Proactively monitors system health, performance, and uptime, ensuring continuous service availability using advanced monitoring and observability tools.
- Identifies recurring incidents and initiates root cause analysis for long-term resolution.
- Collaborates with cross-functional teams, including Applications, Infrastructure, Security, and Cloud teams, to resolve incidents.
- Configures, troubleshoots, and maintains network devices (e.g., routers, switches, firewalls) and ensures secure remote access (VPN, remote desktop solutions).
- Manages and maintains cloud infrastructure (AWS, Azure, GCP), including virtualization (VMware, Hyper-V) and automation (Terraform, Ansible).
- Develops and refines operational runbooks, playbooks, and response procedures, focusing on improving cloud governance and security.
- Participates in on-call rotations to support incident handling outside of normal business hours.
- Contributes to the continuous improvement of monitoring tools, cloud services, and incident management processes.
- Prepares and delivers post-incident reports, root cause analysis, and lessons learned to Senior Management.
- Ensures that SLAs related to response times, escalation, and ticket handling are met consistently.
- Coordinates shift handovers with detailed incident reporting and supporting documentation.
- Leads efforts on system administration (Windows, Linux, Mac OS), backup and disaster recovery procedures, and server management.
- Participates in project management efforts, capacity planning and risk management for ongoing operations.
EDUCATION/EXPERIENCE
-
- Education: Minimum of High School diploma or equivalent required. Bachelor’s degree in Computer Science, Software Engineering, or related discipline preferred.
- Experience:Â Minimum of 3 years of experience in IT operations, HelpDesk, or similar roles, with a minimum of 1 year of experience with VPN, remote access technologies, and network monitoring required. Experience with Windows, Linux, and/or Mac OS administration.
PREFERRED CERTIFICATIONS
-
- Comp TIA Network+
- Cisco Certified Network Associate (CCNA)
- Microsoft Certified: Azure Administrator Associate
- AWS Certified Solutions Architect – Associate
- Google Professional Cloud Architect
- Red Hat Certified System Administrator (RHCSA)
- Certified Ethical Hacker (CEH)
- CompTIA CySA+ (Cybersecurity Analyst)
- Certified Information Systems Auditor (CISA) – ISACA
- GIAC Security Essentials (GSEC)
- PRINCE2 Practitioner
- Agile Certified Practitioner (PMI-ACP) – PMI
- Certified ScrumMaster (CSM)
- ITIL Practice Manager (PM)
SKILLS NEEDED: Network & Infrastructure Management
-
- Network configuration and troubleshooting
- VPN and remote access technologies
- Cloud networking (AWS, Azure, Google Cloud)
- Virtualization technologies (VMware, Hyper-V, KVM)
- Storage solutions (SAN, NAS, DAS)
- Server management and configuration (Windows, Linux)
- DNS, DHCP, TCP/IP protocols
SKILLS NEEDED: System Administration
-
- Windows, Linux, and Mac OS administration
- User and group management (AD, LDAP)
- Patch management and system updates
- Backup and disaster recovery procedures
- Server health monitoring and performance tuning
SKILLS NEEDED: Cloud & Virtualization
-
- Cloud platform management (AWS, Azure, GCP)
- Cloud services (IaaS, PaaS, SaaS)
- Cloud security and governance
- Cloud automation tools (Terraform, CloudFormation)
SKILLS NEEDED: DevOps & CI/CD
-
- Monitoring and observability (Prometheus, Grafana)
- Incident and change management
- Scripting and automation (Python, Bash, PowerShell)
SKILLS NEEDED: Security & Compliance
-
- Firewalls, IDS/IPS, and VPNs
- Endpoint security and antivirus solutions
- SIEM platforms (Chronicle, Splunk, QRadar)
- Vulnerability management (Nessus, Qualys)
- Identity and Access Management (IAM)
- Compliance standards (ISO, NIST, GDPR, HIPAA)
- Data loss prevention (DLP)
- Network security protocols (SSL/TLS, IPsec)
SKILLS NEEDED: Database Management
-
- Database administration (SQL Server, MySQL, Oracle)
- Data backup and recovery
- NoSQL databases (MongoDB, Cassandra, Redis)
SKILLS NEEDED: Monitoring & Observability
-
- System and application monitoring (Nagios, Zabbix, SolarWinds)
- Log management and analysis (ELK Stack, Splunk)
- Cloud monitoring (CloudWatch, Azure Monitor)
- Event correlation and root cause analysis
SKILLS NEEDED: End-User Support & Troubleshooting
-
- Desktop support (Windows, Mac OS)
- Ticketing and help desk systems (JIRA, ServiceNow)
- Hardware and software troubleshooting
- SLA management and tracking
SKILLS NEEDED: Automation & Scripting
-
- Scripting languages (Bash, PowerShell, Python)
- Automation tools (Ansible, Puppet, Chef)
- Workflow automation
SKILLS NEEDED: Project Management & Documentation
-
- Project management frameworks (Agile, Scrum, ITIL)
- Change management processes
- Documentation standards (SOPs, runbooks)
- Risk management and mitigation
SKILLS NEEDED: Data Analytics & Reporting
-
- Data visualization tools (Power BI, Tableau)
- Basic data analytics and query skills
- KPI monitoring and reporting
WHAT WE OFFER
-
- Work-Life Balance
- Modernized Historical Setting in East Sacramento
- Free Lot Parking
- Paid Time Off
- Paid Holidays
- Retirements Savings Match
- Group Health Insurance (Medical, Dental, and Vision)
- Life and AD&D Insurance
- Long Term Disability Insurance
- Accident and Critical Illness Insurance
- Flexible Savings Accounts
- Paid Community Volunteer Day
- Employee Assistance Program
- Tuition Reimbursement Program
- Employee Referral Program
- Diversity, Equity and Inclusion Program
$74,238 – $111,390 a year
Related Posts
Synopsis. The plot follows Senior Chief Petty Officer Ben Randall...
Hindustan Unilever Limited is an Indian fast-moving consumer goods company,...
Sky UK Limited, trading as Sky, is a British broadcaster...