• Claims Supervisor

    Job Location(s) US-CA-Alhambra
    Job ID
    2018-1652
    # of Openings
    1
    Category
    Worker's Compensation
    Job Type
    Regular Full-Time
  • Overview

     

     

    TRISTAR Insurance Group began as an insurance program manager and medical malpractice claims administrator in 1987. Workers compensation claims management services were added in our offerings in 1989, and the Company was renamed TRISTAR Risk Management in 1995. As managed care and benefits administration services were added to our offerings, the organization grew into TRISTAR Insurance Group.

    Since our merger with Risk Enterprise Management in 2012, we became the largest privately held third party claims administrator. We empower more than 1,000+ professionals in offices throughout the United States, focusing business operations in three divisions: property casualty claims management, benefits administration, and managed care services.

    We are true to our values of RESPECT, INTEGRITY, TRUST, and EXCELLENCE, making the right choices both financially and ethically.

    At TRISTAR we strive to create an environment of respect, wherein all of us are encouraged to learn and to grow, to provide exceptional service to our clients and in turn to enjoy the satisfaction that comes from a job well done. We believe that to provide real service, we must contribute something which cannot be bought or measured with money: sincerity and integrity.

    At TRISTAR, you help create a world in which together we "transform risk into opportunity".

    Responsibilities

    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.

     

     

    DUTIES AND RESPONSIBILITIES:

     

    • Directly supervises examiners and clerical staff. Includes monitoring attendance, job performance, evaluations, and disciplinary issues.*
    • Reviews and approves reserve changes, awards and payments based upon City of Los Angeles claims handling instructions.*  
    • Complete supervisor reviews to ensure compliance based on state laws and TRISTAR best practices.*
    • Establishes appropriate supervisory diaries on claim files and completes pending diaries on or before scheduled due dates.*
    • Prepares for claim audits, reviews audit results, and provides appropriate rebuttal feedback.*
    • Coordinates and leads training sessions for staff on updated laws, policies, and procedures.*
    • Ensures daily caseload staffing requirements are met.*
    • Responds to claimant and vendor concerns and issues as needed.*
    • Ensures client servicing instructions are being adhered to.*
    • Facilitates internal and external audits.*
    • Other duties as assigned.
    • Responsible for all personnel transactions for subordinates assigned to them (time cards, PTO requests, performance reviews and administrative actions

     

    *Essential job function.

    Qualifications

    QUALIFICATIONS REQUIRED:

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

     

    Knowledge, Skills and Abilities:

    • Technical knowledge of statutory regulations.
    • 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.  SIP required.

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