• Claims Supervisor Workers Compensation B

    Job Location(s) US-CA-Santa Ana
    Job ID
    # of Openings
    Worker's Compensation/COLA
    Job Type
    Regular Full-Time
  • Overview

    POSITIONS SUPERVISED: Directly:  Claims Examiners, Claims Assistants; may supervise File/Mail Clerks, Data Entry Clerk, Receptionist, Administrative Clerk and Administrative Assistant.



    POSITION SUMMARY:  Under minimal supervision manages and directs activity of claims unit ensuring high-quality results and management of claims in compliance with state laws and company procedures.


    This position requires considerable interaction with clients, management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.




    • Directly supervises examiners and clerical staff. Includes monitoring attendance, job performance, evaluations and disciplinary issues.*
    • Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.*
    • Reviews and approves reserve changes, awards and payments within Company guidelines.*
    • Performs file reviews to monitor compliance with policies and laws.*
    • Coordinates and leads training sessions for staff on updated laws, policies and procedures.*
    • Ensures daily caseload staffing requirements are met.*
    • Supervises and approves check runs and registers daily.*
    • Responds to claimant and vendor concerns and issues as needed.*
    • Monitors effectiveness of vendors and modifies panels as needed.*
    • Ensures client servicing instructions are being adhered to.*
    • Provides coverage for examiner vacancies due to vacation or vacancies.*
    • Prepares and evaluates monthly client reports.*
    • Facilitates internal and external audits.*
    • Conducts and documents in-house and outside educational sessions.
    • Attends client file reviews.
    • Partners with corporate office and sales/service team for RFP’s and client service issues.
    • Other duties as assigned.


    *Essential job function.





    Education/Experience:  Bachelor’s degree in related field (preferred); three (3) to five (5) years related experience; or equivalent combination of education and experience. 


    Knowledge, Skills and Abilities:         

    • Technical knowledge of statutory regulations and medical terminology.
    • Ability to work on a diary system, prioritize tasks and meet strict deadlines.
    • Strong analytical skills.
    • Proficient in Word and Excel.
    • Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
    • Ability to manage employees of various skill levels.
    • Excellent interpersonal skills.


    Other Qualifications

    • Certifications and/or licenses as required by State regulation.


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