Work Comp Claims Manager

  • Madison, WI
  • Claims

Work Comp Claims Manager

Website The James Allen Companies Inc.

GENERAL DESCRIPTION
The Claims Manager oversees and directs daily claim operations over multiple business units in a manner that ensures the highest levels of customer service and job satisfaction.
ESSENTIAL FUNCTIONS
1. Manage all claim operation units to ensure that superior service is provided in accordance with company Best Practices and good faith settlement practices.
2. Monitor compliance with all applicable State and Federal regulations ensuring that all relevant staff are applying regulations to claim activities and documentation.
3. Work with the business units ensuring that staffing levels are maintained at a high level, minimizing turnover and embracing effective recruitment strategies. Optimal candidates are individuals that are fit for each job role, with a career-oriented focus and entrepreneurial-minded individuals.
4. Monitor performance objectives of claims staff and work with Director of Learning and Development and Unit Supervisors to continuously improve gaps in learning.
5. Navigate program management aspects including monitoring and evaluation of technical and financial performance through review of productivity, litigation, and subrogation.
6. Manage the annual performance appraisal process to include completion and review of assessments and salary recommendations.
7. Coordinate vendor management, addressing quality, effectiveness of service, and adjustments in pricing under the direction of the CCO. This includes review and assessment of effective vendor partnerships where continuous development is needed in underserved jurisdictions.
8. Conduct quarterly Supervisor Objectives for Learning in line with business objectives set forth by the CCO.
9. Monitor customer service levels by tracking complaints and escalate service-related issues to Executive Claims in accordance with our policy.
10. Complete supervisory/managerial audits within 30-days of task due date.
11. Utilization of the PS dashboard and predictors for effective decision making, identification for reserving effectiveness and/or adjustments to development, recoveries and closing targets.
12. Monitor new loss assignment tasks and overall caseloads to maintain a consistent distribution and a standard caseload size of 125 per indemnity analyst and 150 per medical-only, through full staffing and adherence to minimum productivity standards.
13. Ensure timely investigations, reserving to UPC, high level CRM & productivity.
14. Ensure all team members adhere to diary standards that promote timely completion and avoidance of prolonged aging, i.e. PowerSuite, ImageRight tasks.
15. Oversee the setting of reserves to Ultimate Probable Cost (UPC). Approve reserves for anticipated exposure subject to authority limits while effectively managing adjusting staff authority for settlement and reserving, commensurate with experience.
16. Reduce the overall amount of indemnity overpayments through timely wage calculations and diligent pursuit of recovery/credit.
17. Review of benefit escalation tasks for timely issuance and compliance.
18. Monitor compliance to our Account Services policy collaboratively with all departmental stakeholders.
19. Management of our CPA policies, i.e. escheating, aged receivables, cash receipts and bill turnaround time.
20. Oversight of the Customer Care team to maintain the highest levels of customer service including, but not limited to, monitor of call queue times, new loss turnaround time, MPN provider nomination and compliance.
21. Maintains that claims staff adhere to our Data Calls – Claims Statistical Data Entry Policy, where data fields are entered at the highest level of accuracy. Coordinates appropriate corrections and maintenance with key stakeholders related to the various calls for data under the direction of Executive Claims.
22. Maintain a personal caseload of (5) Serious/CAT Claims assigned by executive Claims.
23. Other duties and projects as assigned.
COMPETENCIES/QUALIFICATIONS
1. Candidate must possess strong communication, written, interpersonal, analytical and organizational skills.
2. Strong ability to execute detailed verbal and written instructions and respond effectively and efficiently.
3. Readily control/handle problem issues in times of stress and in a climate of conflict and/or adversity.
4. Candidate should have a strong ability to review and analyze data and make sound decisions based upon that analysis.
5. Strong knowledge of claims procedures, policies, technology, state and federal law regarding insurance and the elements of intent, material misrepresentation, evidence, and restitution.
6. Responsiveness to changing business needs and the ability to multi-task.
7. Ability to take direction and make decisions.
8. Candidate should have the ability to work well as part of a team and independently with limited supervision.
9. Ability to adhere to the code of ethical conduct and engage in fair claim settlement practice.
10. Strong computer skills including Microsoft Office Suite and ability to work with investigative databases and jurisdictional reporting requirements.
EDUCATION/EXPERIENCE REQUIREMENTS
• Minimum Education: Bachelor’s degree and/or 8 or more years of relevant workers compensation experience is required.
• 2-5 years of supervisory or management experience is preferred.

SUPERVISORY RESPONSIBILITY
The Claims Manager oversees multiple business units, assigned by region, within a Branch. This position has 5-7 direct reports.

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