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Claims Manager - Workers Compensation

Employer
Claims - Workers Comp - Confidential Company
Location
Los Angeles, California
Salary
Competitive salary with bonus
Closing date
Oct 3, 2020

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Summary:

Plans, organizes, manages claim staff and controls the activities in the Branch Claim Office within specific guidelines, directives and authority to ensure workflow is being managed properly to ensure high customer service levels.

 

Responsible for the implementation and practice of all claims handling guidelines and directives as outlined in various claim manuals, policies and bulletins to ensure regulatory and company compliance. Is also responsible to adjust assigned claims within delegated limits of authority, conduct investigations and complete fair and equitable claim settlements.

Essential Functions:

  • Receives new claim assignments and analyzes the nature of the claim or loss to determine required investigation and handling. Determines and identifies coverage issues or questions of compensability.
  • Is responsible for ensuring proper assignment and management of Workers’ Compensation claims adjusted within the Branch Claim Office. Ensures compliance with the investigation, management and settlement of all reported claims in accordance with company Claim Handling Guidelines, jurisdictional regulations and Fair Claims Practices Acts.
  • Is accountable for establishing and authorizing timely and adequate case reserves within delegated reserve/settlement authority and provides appropriate recommendations to Management where reserve evaluation exceeds delegated authority.
  • Responsible for conducting and or supervising all necessary information related to assigned claims in the Branch Claim Office, as well as evaluating completed investigation and case facts to determine merits of each claim.
  • Conducts internal quality control audits to ensure full compliance with company Financial, Operational and Claims Handling Guidelines.
  • Maintains diary and ensures appropriate file documentation and claims system documentation as required by company claim manuals and procedures. May be responsible for submission of claim forms and reports required by outside agencies.
  • Investigates and evaluates recovery and fraud potential. Provides oversight and instructions on all recovery and special investigation activities to ensure full compliance with all company and regulatory requirements.
  • Communicates to claims staff information regarding policy, plans, trends, results and objectives of the company.
  • Ensures Home Office Claim Staff company is informed of all new and continuing developments on claims being reportable under published guidelines.
  • Ensures compliance with all adjuster licensing regulations and requirements.
  • Participates in miscellaneous associations; trade groups to ensure remains up to date in all regulatory and trade news and regulatory updates.
  • Participates and/or manages special projects and assignments as needed.
  • Supervisory Responsibilities:
  • Develops and maintains an efficient and enthusiastic claims staff to resolve all reported claims promptly, professionally and fairly in accordance with applicable contract provisions, legal regulations and guidelines, and company claim handling policies and procedures. Is responsible for the overall direction, coordination, and evaluation of the staff in the department. Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems to maximize individual contributions that will achieve desired business results within the department and company.
  • Delegates appropriate authority to allow claim staff to handle assigned claims with efficiency and effectiveness.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education / Experience Required:

High School Degree or G.E.D. is required. Bachelor’s degree is preferred.

7+ years related WC Claims experience is required

4+ years in supervisory or management role

 

LANGUAGE SKILLS: Individual must have the ability to:

· Read, analyze, and interpret general business periodicals, professional.

· Write reports, business correspondence and presentations.

· Create effective presentations and effectively deliver them and other information verbally, plus respond positively to questions from groups of managers, customers and the general public.

 

MATHEMATICAL SKILLS:

· Ability to accurately calculate figures and amounts such as discounts, interest, commissions, percentages, etc.

 

REASONING ABILITY: Individual must have the ability to:

· Solve day-to-day business problems and deal with a variety of concrete variables in situations where only limited standardization exists.

· Interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

 

COMPUTER SKILLS: Word, Excel, PowerPoint. Knowledge of claim application systems including IVOS and Guidewire preferred

Other Qualifications Required:

AIC, CPCU, or Claims Law Designation preferred.

Other Skills and Abilities Required:

· Must be able to develop and maintain strong business relationships as well as having the ability to deal effectively with difficult or sensitive situations.

· Must be able to work independently and as part of a team.

· Same day and overnight travel required ( 10%)

Competencies: To perform the job successfully, an individual should demonstrate the following.

Core Competencies Communication, Customer Focus & Teamwork

Managerial Competencies Performance Management & Development and People Learning

Job Specific Competencies Excellent organizational, delegation and negotiation skills

 

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The company provides reasonable

accommodation to enable individuals with disabilities to perform the essential functions of the job in accordance with applicable law.

Regularly Frequently Occasionally, Sitting, Standing, Walking, Climbing/Balancing, Reaching with Arms/Hands , Stooping/Kneeling/Crouching/Crawling,Talking,Hearing

Vision – Close/Peripheral/Depth/Ability to Adjust Focus

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The statements herein are intended to describe the general nature and expectations for this position, and are not to be an exhaustive list of required functions, skills and competencies. This job description does not establish a contract for employment and is subject to change at the sole discretion of the Company.

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