VP & Manager Workers Compensation Examining
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The Manager of Workers Compensation Examining provides oversight and management of the WC Examining Functions, to include WC Examining, Catastrophic Case Management Unit (CCMU), and Life Pension, in their daily activities of analyzing and evaluating significant exposure WC Claims from several standpoints including Coverage, Compensability, Medical Exposure and establishment of commensurate Reserves for both Indemnity, Medical and Expense. A member of the extended Senior Leadership team, who coordinates the operation of the Examining unit to ensure proper alignment, collaboration and partnership with internal and external business partners. A significant portion of the duties will include direct supervision of a team of Unit Managers and indirect supervision of WC Examiners, CCMU nurses and Life Pension analysts. The unit provides case management direction and support to Field Regional Claim Specialists, Managed Care partners, internal and external business partners, provides evaluation of settlement values and reserve exposures and strategies on significant exposure, catastrophic and complex claims.
- Oversees and manages a team of technical experts in the area of WC Examining, CCMU, and Life Pension, who manage a full range of complex, unique and significant exposure claims. The unit partners with the field claim operations to bring about the optimal claim outcome on assigned claims.
- Is responsible for staffing, workload and budget/planning activities that align with GRS WC Claims goals, outcomes and objectives.
- Maintains a working reserve and settlement authority of $1,500,000; (or as defined in the future by the Chief Claims Officer) effectively, efficiently and accurately leveraging same to bring said complex/significant exposure claims to resolution while ensuring reserve/financial accuracy. Elevating claims above authority to senior leaders for discussion and approval.
- Acts as designee when requested by Senior Leadership to attend high level customer, regulatory, or business partner meetings.
- Works collaboratively with internal business partners to address, create and/or enhance existing programs, workflows, processes, and procedures to ensure continuous improvement in same driving best in class results, outcomes and programs.
- Acts as liaison between GRS/LMI and regulatory and/or state agencies at the request of Senior Leadership.
- Participates in regular Examining and CCMU conference calls regarding compensability, coverage, reserving and settlement evaluations ensuring proper resources are included, accurate strategy in place, and proper business partners made aware of same.
- Works closely with the Loss Recovery Unit to achieve proper and timely global settlements.
- Works closely with the Region Managers to ensure alignment with the respective Examining/CCMU/Life Pension teams understanding region goals, challenges, objectives and strategies. Works closely to assist said regions in obtaining their objectives.
- Communicates with other departments to offer advice on the specifics, exposures, defenses and handling of high exposure, complex or unique claims.
- Prepares reports to superiors, other departments and outside personnel on the results, status and strategies on cases.
- Participates as an instructor in seminars, conferences and workshops within and outside the claims department.
- Maintains a proficient working knowledge of Medicare Compliance including MSAs, Section 111 Reporting, Conditional Payments
- Proficient working knowledge of Reversionary Interest, structured settlements, and professional administration
- Excellent verbal and written communication skills
- Lead and/or act as a Subject Matter Expert on cross-functional project teams
- Lead a team of technical experts (Examiners, CCMU Nurses, and Life Pension Analysts) to include coaching, mentoring, training, performance reviews, and leveraging own technical expertise in achieving department objectives. Achieve work through others direct reports and business partners. Assist VP & Manager of Technical Solutions when/where required.
Demonstrated ability to lead and manage a highly experienced technical team of individuals in the oversight of significant exposure, catastrophic, complex and unique claims. Ability to work well and in conjunction with large national account customers, understand special service instructions and build partnerships with Account/Service Managers, Underwriters, Distribution and Agents/Brokers. Extensive knowledge of Claims Department procedures and operations a plus. A Bachelors degree or equivalent, 10+ years of related claims experience, and prior management experience required.