Claims Manager - Workers Compensation TPA

Job Description

Provides strategic and technical claims leadership for staff. Manages claims staff to ensure appropriate claim outcomes through consistent execution of best claims practices. Directs staff in the achievement of business plan goals and compliance with legal statutes, policy provisions and company guidelines. Supervises the execution of quality assurance programs. Identifies training needs and manages claims training. Ensures delivery of timely, high quality customer service.

Responsibilities

• Develops, recommends and implements short and long range objectives consistent with company business goals, guidelines and programs.
• Ensures quality management of claims in accordance with best practices and company guidelines.
• Maintains appropriate staffing levels in conjunction with work loads
• Selects, trains and manages staff. Plans staff responsibilities and manages activities, utilizing staff resources effectively to meet department goals in accordance with approved plans and budgets. Develop staff to respond to department needs as well as assisting the claims staff with career development goals.
• Plans and develops annual expense budget for areas of direct responsibility. *Manages adherence to budget.
• Identifies training needs for staff. Establishes and implements strategy to deliver and or coordinate the delivery of training.
• Establishes documents and communicates claims settlement and reserving authorities for claims professionals. Grants reserve and settlement authority on cases exceeding supervisor's authority levels.
• Responsible for ensuring execution of CIR program, inclusive of identification of strengths and deficiencies and implementation of action plan focused on improved results.
• Monitors and analyzes significant legal developments and legislative changes in service territories that may affect claim operations. *Communicates conclusions and recommendations
• Participates in claim conferences at which strategy, reserves and settlement authority is established on the most complex and or highest value claims. *Responsible for managing execution of action plans.
• Utilizes performance management and performance review processes effectively, on an ongoing basis, to maximize performance of employees, correct performance problems, provide development opportunities, and promote effective communication with employees.
• Promotes effective communication among and between work groups, and between management and employees.
• Collaborates with Underwriting, Risk Control, Product Development, Marketing and other departments.
• Ensures a superior level of customer service. Manages account management process and resolution of service issues.
• Participates in defense counsel evaluation process. Makes recommendations for addition/deletion of counsel.
• Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
  
  

Requirements

Requirements:

• Bachelor's Degree or equivalent experience; 10 or more years of Workers Compensation claims experience in positions of increasing responsibility required; at least 5 years of Workers Compensation Supervisory experience required
• IL, MN experience required (7 or more years)
• IA, WI, NE, KS, MO, MI, OH, IN jurisdictional experience strongly desired
• TPA experience and client management experience required
• Extensive knowledge of claims regulations and applicable law is required
• Prior experience handling/managing claims for self-insured entities will be needed
• Extensive knowledge of self-insured programs, adjusting techniques and medical terminology
• Previous experience in a leadership position with proven record of successful team building, goal achievement and superior customer service is required
• The ability to effectively lead supervisory level staff will be needed
• Excellent verbal and written communication skills
• Professional designations desired (CPCU, ARM, AIC, etc.)