TPA Claims Director - Roseville, CA

The Director will have responsibility for providing strategic and technical claims leadership for staff in one or more established and developing claims regions for PMA Management Corp. The Director is ultimately responsible for the achievement of appropriate claim outcomes, client retention, high customer service levels, and the achievement of business plan goals; all while ensuring compliance with regulatory requirements, industry best practices, execution of consistent quality of services delivered, and adherence to company guidelines.

Responsibilities:

• Provides leadership to PMA Management Corp.'s Workers' Compensation book of business in one or more regions.
• Establish policy and procedures to ensure compliance with best practices, claims management service standards, special handling instructions, carrier and client requirements.
• Provide recommendations to senior leadership relative to business planning with an emphasis on achieving the TPA's annual growth, profit and revenue goals/objectives.
• Maintain appropriate corporate staffing models and evaluate workloads as required.

• Plans and develops annual expense budget for areas of direct responsibility. Manages adherence to budget.

• Ensure initiatives that drive ongoing process efficiencies and existing protocols are effectively executed.
• Develop and execute consistent, viable business strategies to improve employee retention, engagement and drive positive employee morale.
• Monitor and analyze significant developments and legislative changes in service territories that may affect claim operations. Communicate trends, issue and recommendations to leadership, staff, and other appropriate internal stakeholders.
• Maximize performance of employees and provide opportunities for growth and development by providing training, coaching and development. Promote effective communication among all within the organization.

• Utilizes performance management and performance review processes effectively, on an ongoing basis, to maximize performance of employees, correct performance problems, and provide development opportunities.

• Utilize data analytics and internal quality assurance protocols to develop metrics to ensure profitable and desired claims outcomes.
• Ensure appropriate execution of quality assurance processes, inclusive of identification of strengths, areas of opportunity and implementation of action plans, when necessary, that focus on improved results.

• Grants reserve and settlement authority on cases exceeding manager's authority levels.

• Collaborates with Claims, Sales, Account Management and other department employees on strategic initiatives.

• Ensures a superior level of customer service. Provides active client sponsorship, engagement with key customers and sales/client service support as needed.
• Displays strong understanding of the customers and their programs.

• 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.

• Bachelor's degree or equivalent combination of education and experience typically defined as 10 years of workers compensation claims experience in positions of increased responsibility.
• California TPA experience required (7 or more years).
• 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 supervisor and manager level staff will be needed.

• Excellent verbal, written communication and presentation skills.
• Proven ability to effectively interact with executives and clients.
• Ability to maintain confidential information and work independently and in a team.
• Strong analytical acumen.
• Strong organizational skills.
• Ability to multi-task.

• Professional designations desired (CPCU, ARM, AIC, etc.).

• Travel (15%).