Description:SUMMARYThe primary responsibility of the Claims Manager WC is to manage and direct the activity of the workers’ compensation claims adjusters ensuring high-quality results and management of claims in compliance with State laws and defined organizational procedures.
DUTIES & RESPONSIBILITIESDirect supervision of WC claims adjusters.Ensure that adjusters are adhering to Salus Best Practices, Salus Claims Protocols, Claims Handling Guidelines, and client-specific requirements.Coach and develop a team of claims adjusters responsible for the management, investigation, coverage opinions, compensability determination, and resolution of claims including settlement.Use various tools to evaluate operational effectiveness and identify areas of opportunity.
Exercise discretion and independent judgment in the management of claims operations and in the management of adjusters.Motivate and lead a high-performing team by attracting, onboarding, recruiting, and retaining team members.Evaluate and maintain claims’ outcomes, monitor attendance, evaluate job performance and address disciplinary concerns.
Plan and organize claim management strategies, problem-solving and provide feedback to leadership.
Review and approve reserve changes, payments, and settlements that are outside of the adjusters’ assigned authority.Implement claims operational initiatives.Interact collaboratively and work efficiently throughout the organization.Foster an environment of shared responsibility and accountability while promoting teamwork, collaboration, continuous learning, and process improvement.
Ensure daily caseload and staffing requirements are met among direct reports and ensure an equitable distribution of workload when appropriate.
Perform internal audits and preparation for external audits.
Be available to the claims team for collaboration and utilization of third-party vendor referrals, action plans, and resolution development.
Maintain technical knowledge of statutory regulations and required state adjuster licenses.
Recognize reinsurance thresholds and report to reinsurance carriers when needed as well as request reimbursement.Oversee new and continuing education for adjuster needs.Provide external TPA claims oversight to claims handed outside of Salus.
Perform other duties or special projects as assigned.COMPETENCIESIn-depth knowledge of workers’ compensation insurance principles and laws, as well as cost containment principlesDetail-oriented with the ability to work in a team environmentExcellent customer service, written and verbal communication skills Ability to prioritize and balance multiple projects simultaneouslyResults-driven, proactive & able to work autonomously SUPERVISORY RESPONSIBILITYThis role has supervisory responsibilities.
Requirements:TECHNICAL SKILLS REQUIREDProficient in Microsoft Office Suite, PDF Professional, G Suite, or similar software.WORK ENVIRONMENT & PHYSICAL DEMANDSUnless fully remote, this position operates in a professional office setting and routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.
This is largely a sedentary role with prolonged periods of sitting at a desk and working on a computer.
However, some filing is necessary and may require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.POSITION & EXPECTED HOURSThis is a full-time, salaried exempt position.
Typical work hours and days are Monday through Friday, from 8:00 am to 5:00 pm.
Some flexibility in hours is allowed, however, the employee must be available during the ” Core” work hours of 9:30 am to 3:30 pm and must work 37.5 hours each week.TRAVELAble to travel as needed.EDUCATION AND EXPERIENCEBachelor’s degree from an accredited college or university preferredCalifornia experience a MUSTSpanish bilingual preferredBachelor’s degree from an accredited college or university preferred5-8 years of experience in claims management and leadershipA combination of education and experience in an insurance company (TPA or brokerage environment) will be considered State adjuster’s licenses as requiredInsurance accreditation preferredBENEFITSMedical, Dental, and Vision 401k MatchingHSA Contribution4 Weeks’ Paid Maternity LeaveHybrid/Remote/On-site Work37.5 Hour Work WeekAbout MethodMethod Workers’ Compensation is a portfolio of workers’ comp companies with the same mission: minimizing the human and financial cost of workplace injuries.
We mitigate workplace injuries and deliver exceptional healthcare outcomes for injured workers, expediting a return to work, preserving families’ livelihoods, and enhancing employers’ productivity.
We maintain in-house expertise in claims management, medical bill review, underwriting and loss prevention for high-hazard, high-mod, and mid-market risks.
From submission to claim, we’re there every step of the way, improving outcomes for everyone involved.
Method currently operates in all non-monopolistic states.PM21PI187920299