ADP is hiring a Lead Claims Examiner. In this position you will perform the following basic functions:

Supervisory responsibility for Claims Examiner I and Senior Examiner To aid in overall claim cost reduction by coordinating efforts between all involved vendors, clients and WES. Additional level to monitor applicable claims assigned to Claims Examiner I and Senior Examiner To ensure TPA/Carrier accountability in agreed performance standards and coordinate needs for changes with Claims Director To accumulate data for the purpose of creating standards for measurement of various claim related issues, as well as customer service and internal staff performance

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RESPONSIBILITIES:

Reviews and recommends acceptability of all Workers' Compensation Claims within claim distribution Accountability for the Claim Unit's efforts in all RTW efforts, OSHA documentation and all documentation of claim activity according to stated claim procedures. Works directly with Claims Director to determine workloads and the necessity of procedure changes within the Claims Unit Assists in online audits of TPA to insure quality compliance of claim procedures and client satisfaction in Workers' Compensation claims handling. Maintaining e-time and PTO/Sick time coordination for the Claims Unit., has one administrative direct report and mentor/coaching responsibilities for the Claims Examiner. Responsible for communication with internal/external clients, claimants, related vendors as well as TPA/Carrier activity for TotalSource work-site employee claims to include personal visits to each region. Requires basic knowledge of Workers' Compensation laws for all jurisdictions. Attends professional development courses and seminars to keep TotalSource current with related workers' compensation laws and standards. Represents client in legal activities related to Workers' Compensation Claims within authority. To review, audit and support the examiner positions. To generate routine reports for productivity level evaluation. To support the Claims Director in daily/monthly/quarterly tasks and projects that aid in the claim operation reach it's specified goals.

QUALIFICATIONS REQUIRED:

5+ years in WC Indemnity adjusting or industry related experience Experience with complex claims cases

PREFERRED QUALIFICATIONS: Preference will be given to candidates who have the following:

Direct or indirect leadership experience PEO experience  Maintain knowledge of basis Workers Compensation Laws in all applicable jurisdictions Stay abreast of strategies and current industry related ideologies in dealing with Workers' Compensation Claims Maintain adequate resources to enable continued education in Workers' Compensation and RTW issues.

 

 

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