• Claims Manager - Workers Compensation COLA C

    Job Location(s) US-CA-Santa Ana
    Job ID
    2018-1633
    # of Openings
    1
    Category
    Worker's Compensation/COLA
    Job Type
    Regular Full-Time
  • Overview

    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.

    County of Los Angeles Unit C (which includes Fire; Child Protective Services and several other departments) located in Santa Ana to start asap. Claims Manager will assist Branch Manager---to be responsible for day-to-day claims operations and will probably directly supervise all or most claims supervisors in this large office of 80 people.  County has recently implemented new claims management system within past year.   Roughly 9500 files.  Must be SIP certified with high level of technical skills including litigation management on very complex files.  Experience with large offices preferred.  Experience with County of Los Angeles program very helpful.

    POSITIONS SUPERVISED: Supervisors, May supervise File/Mail Clerks or support staff. Acts as a back up to Branch Manager.

    Responsibilities

    DUTIES AND RESPONSIBILITIES:

     

    • All supervisory staff will report directly to the Claims Manager and the Claims Manager will conduct weekly meetings with the Branch Manager on operational issues concerning personnel, clients, staffing, claims, audits, etc.
    • Over sees supervisors, examiners, and clerical staff which can include monitoring attendance, job performance, performance evaluation input, and disciplinary issues to assure quality claims handling to our best practices.*
    • May conduct random audits of personnel and assist with developing plans of actions to address any office or individual audit deficiencies.*
    • Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.*
    • Reviews and approves reserve changes, awards and payments.*
    • Performs file reviews to monitor compliance with policies and laws.*
    • Coordinates and leads training sessions for staff on updated laws, policies and procedures.*
    • Conducts and documents in-house and outside educational sessions.
    • Ensures daily caseload staffing requirements are met.*
    • Supervises and approves check runs and registers daily.*
    • Respond to claimant and vendor concerns and issues as needed.*
    • Monitors effectiveness of vendors 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.*
    • Acts as a back-up for Branch Manager.*
    • Partners with corporate office and sales/service team for RFP’s and service issues.
    • Attends client file reviews.
    • Other duties as assigned.

     

    *Essential job function.

    Qualifications

    QUALIFICATIONS REQUIRED:

     

    Education/Experience: Bachelor’s degree (preferred); five (5) years supervisory experience in workers’ compensation.

     

    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. Must possess Self Insurance Plans certification.

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