• Provide technical and jurisdictional guidance and training to claims examiners and claims support staff
• Staff management by way of conducting monthly quality reviews of claim files to measure claims management of examiners pursuant to client service instructions, contracts, audit requirements and industry’s best practices
• Staff management of claims assistants and clerical support staff by way of periodic audits of measurable goals.
• Provide sound and well developed recommendations to claims examiners on claim management, compensability issues, cost containment, litigation management, resolution and any sensitive issues as determined by the client
• Interviews, hires and establishes a performance assessment of claims team by way of working with staff member in establishing measurable goals and job expectations, facilitates growth and development, monitor and provide documented performance history including a 6 month and yearly reviews
• Identifies problems and issues relating to claims and work flow management and present new office trends, ideas and recommendations to improve efficiency, production and quality of work products
• Coordinates work projects relating to client needs
• Analyzes and reviews management reports and/or Ad Hoc reports and takes appropriate action
• Reviews appropriateness of reserve amounts over claims examiner autonomy
• Provide guidance and establish workflows to prevent/avoid penalty exposure to include but not limited to self-imposed increase due to untimely periodic indemnity payments and awards, Administrative penalties as a result of failure to comply with the UR/IMR Process, LC 5814 penalty as a result of egregious claims actions, LC 5813 penalty due to frivolous and bad faith tactics and penalties/interest due to a late payment of medical benefits.
• Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
• Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written responses per client’s needs
• Assures that direct reports are properly licensed in the jurisdictions serviced.
• Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
• Ensures data integrity by way of adequate documentation made by claims examiners, claim codes are accurately entered
• Performs other duties as assigned.

 

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

 

 

Job Requirements of the WORKERS COMPENSATION CLAIMS SUPERVISOR

 

• Bachelor's degree from an accredited college or university preferred. 

 

• Self-Insured Plan Certificate

• 4850 experience are required.

 

 

• Current with required educational / training hours
• Seven (7) years or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
• Excellent oral and written communication skills including but not limited to presentation skills.
• In-depth knowledge of appropriate principles and laws pursuant to the California WC Laws Practices & Procedures, medical/disability management, SIU/Fraud, litigation rules, Medicare/CMS Rules and ethical issues
• Thorough knowledge of claims management processes and procedures for public entities and agencies is a plus
• PC literate including Microsoft office products
• Detailed oriented and strong organizational skills
• Able to handle multiple tasks in a fast paced environment
• Analytical and interpretive skills
• Ability to work in a team environment, good interpersonal skills
• Leadership/management and motivational skills
• Excellent negotiation skills
• Ability to achieve high performance standards and/or exceed Service Expectations