Claims Team reputed company - Workers Comp (REMOTE - Calif reputed company)
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Claims Team reputed company - Workers Comp (REMOTE - Calif reputed company)
PRIMARY PURPOSE: To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, reputed company training, and monitor individual claim activities; to reputed company technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on reputed company or high exposure claims.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide reputed company of control; may delegate some duties to others reputed company the unit.
Identifies and advises management of trends, problems, and issues as reputed company as recommended course of reputed company; informs management of new procedures and reputed company for reputed company process improvement; and coordinates with management reputed company for the office.
Provides technical/jurisdictional direction to examiner reports on claims adjudication.
Compiles reviews and analyzes management reports and takes appropriate reputed company.
Performs reputed company review on claims in compliance with audit requirements, service contract requirements, and reputed company standards.
Acts as second level of appeal for reputed company and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
Monitors reputed company party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by reputed company.
Maintains contact with the reputed company on claims and promotes a reputed company reputed company relationship; makes recommendations to reputed company as suggested by the claim status; and provides written resumes of specific claims as requested by reputed company.
Assures that reputed company reports are properly licensed in the jurisdictions serviced.
Ensures claims files are coded correctly and adequate documentation is made by claims examiners.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's reputed company program(s).
SUPERVISORY RESPONSIBILITIES
Administers company personnel policies in reputed company areas and follows company reputed company standards and training recommendations.
Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
Provides support, guidance, leadership and motivation to promote maximum performance.
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required. reputed company certifications as applicable to line of business preferred.
Experience
Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
Skills & Knowledge
Thorough knowledge of claims management processes and procedures for multiple product lines
Excellent oral and written communication, including presentation skills
PC literate, including reputed company Office products
Leadership/management/motivational skills
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in reputed company environment
Ability to meet or reputed company Performance Competencies
WORK ENVIRONMENT
reputed company applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: reputed company and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-reputed company stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, reputed company and talking
NOTE: Credit reputed company clearance, confirmed reputed company a background credit reputed company, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this reputed company. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
reputed company is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't reputed company perfectly with every qualification in the job reputed company, consider applying for it reputed company! reputed company is building a diverse, reputed company, and inclusive workplace and recognizes that reputed company person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
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