Unit Manager, Workers Compensation Claims II

Sacramento, California
Not Specified
Apr 16, 2018
Jun 15, 2018
Job Type
Not Specified
Career Level
Not Specified

York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.

Job Description

The Unit Managers primary purpose is to ensure that their assigned team delivers a level of claims and customer service that meets and exceeds our clients expectations on a daily basis. The Unit Manager II is a fully dedicated manager, with a typical span of control of 5-8 direct reports, consisting of technical claims staff, and clerical in some cases.

  • Oversight of Claims Handling Requirements: The Unit Manager (UM) will be held accountable for ensuring that the following claims activities are completed by their examiners in a timely manner which meets both York and client best practices:
    • Three-point contact
    • Investigations
    • Denials
    • Reserving
  • Benefit Delivery: The UM will be held accountable for ensuring that benefits are delivered in a timely manner according to statutory requirements.
  • CMR Production and Supervisor Reviews: The UM is responsible for regular file reviews as required by York and Client Instruction Best Practices. They are responsible for ensuring that staff are compliant with issuing CMRs timely as well as approving CMRs. They are also responsible for reviewing and approving all denials and reserves.
  • Diary Compliance: The UM will be responsible for ensuring that the examiner is complying with York Best Practices and/or Client Service requirements for diary completion.
  • Excess Reporting Compliance: The UM will be responsible for ensuring that files are reported on a timely basis to the excess carrier (if applicable) as well as reporting on any required forms with all supporting documentation required.
  • Closing Ratio/Inventory Reduction: The UM will be responsible for ensuring that their team achieves a closing ratio as required by York Best Practices and/or Client Service Instructions in order to maintain or reduce file inventory.
  • Penalties and E&Os: The UM will be responsible for ensuring that the Examiner incurs no penalties or Errors & Omissions (E&O) on the files that they handle. This should be accomplished by handling all significant claims activities in a timely manner and issuing all benefits due in a timely manner.
  • Significant Claims Activities: The UM will be responsible for ensuring that those claims with significant claims activity are properly managed from inception to resolution. These claims include but are not limited to high dollar and complex claims. This process will also include delivering exceptional customer service to our clients in partnership with our client services team.
  • Regular File Reviews: The UM will be responsible for conducting regular file reviews for clients as required by the client instructions. The UM will review all CMRs selected to ensure they are appropriate before presenting to the client.
  • Statutory Requirements: The Examiner will be responsible for complying with all State Statutory Requirements and maintaining all State educational requirements.
  • External Audits Preparation & Response: The UM will be responsible for preparing for and responding to external audits in coordination with our client services team. This would include implementing changes to improve performance if necessary.
  • Human Resources: The UM will be responsible for working closely with the Human Resource department on any performance issues, recruitment, and performance reviews.
  • Employee Recognition: The UM will be responsible for recognizing employees for exceeding specific performance goals, receiving positive client feedback, or achieving educational goals.
  • Client Relations: The UM will work with the Client Relations team on customer service issues, attend client meetings & support staff when dealing with clients.
  • Continuous Improvement: The UM will be responsible for promoting continuous improvement by providing input. York encourages staff to always look at ways to improve processes or systems.
  • Training Clients: The UM will be responsible for assisting in training clients within their area of expertise and as requested by the clients.

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