Job Description SummaryProvides overall managerial and supervisory responsibilities of the worker’s compensation (WC) claim portfolio. Investigates all WC claims and oversees third party administrators’ (TPA) claim practices and proper utilization of insurance carrier claim representatives, medical case management, and other contact vendors as the need arises.Job DescriptionMajor ResponsibilitiesUtilizes and directs TPA personnel and oversees their claims management practices and management of approved WC vendors.Manages timely and accurate lost work day panels.Ensures claims are adequately reserved at all times, that reserves are adjusted timely and appropriately based on the current support in the claim file, and that appropriate documentation that speaks to the value of the case has been or is being requested by the file handler.Assists the WC Director with claim requests by sharing any information that they have found during their oversight of the case.Documents his/her activities on all their pending cases in the RIMS system. Ensures that they see the file on a suspense date that meets the WC Director’s expectations. No suspense or follow up by the examiner on any one file will exceed 90 days.Ensures that all reporting requirements by our carrier and/or our company are met by the file handler.Tracks or generates TPA reports for a variety of metrics for the WC Director, such as lag time, pending per adjuster, etc.Gives the necessary direction to the claim handler to ensure that the file quality meets or exceeds 90%.Brings any quality or handling issues to the attention of the claim management staff. Audits compliance to the application of claim handling best practices for workers compensation.Ensures that locations follow the WC FORM process and/or may be involved in training of our locations concerning the WC FORM process.Trains claim personnel or collaborates with other team members concerning training modules to be rolled out and/or implemented.Ensures that all claims are managed to the highest standard, whether by external TPA or internal staff, eliminating unnecessary payments and minimizing the costs of handling claims.Assists the file handlers in ensuring that sound litigation management occurs and that the performance of external counsel is moving a file to the most direct & cost effective resolution.Maintains a diary for all files assigned by WC Director.Advises the WC Director of any issues that may come up with any vendors that are assisting on the file or in the department.Other responsibilities as required or requested.

Minimum Education or Certifications RequiredBachelor’s degreeAdvanced degreeAdjuster’s LicenseBusiness - Insurance Studies

Minimum Experience or Skills Required5+ years experience in Claims Management.Previous experience in Worker’s Compensation Investigation Techniques, Human Resource Management, and Worker’s Compensation Insurance Principles.Strong written, verbal, and interpersonal communication skills with an acute ability to listen attentively and to communicate information clearly and effectively throughout all levels of the organization with audiences of varying degrees of familiarity with materialResults-driven, action-oriented and self-motivated mindsetAbility to manage multiple projects simultaneouslyStrong computer skills with Microsoft Suite including Word, Excel, PowerPoint, and Outlook or comparable software application

Physical Requirements and Working ConditionsIncumbent must be able to move about the office and between floors; utilize standard office equipment; access filing system/cabinets; and communicate effectively and efficiently in person or by telephone.Occasional local and/or domestic travel.
Disclaimer
Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. This job description reflects management’s assignment of essential functions, it does not prescribe or restrict the tasks that may be assigned.

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