Workers Compensation Claims Supervisor

POSITION SUMMARY: Under minimal supervision, oversees the daily operations of a workers’ compensation claims unit, ensuring timely, accurate, and high-quality claims handling in compliance with applicable state laws, client requirements, and company policies and procedures.

Provides technical guidance, training, and performance oversight to assigned staff and regularly interacts and collaborates with clients, management, Claims Examiners, and other TRISTAR personnel to resolve claims and service issues.

DUTIES AND RESPONSIBILITIES:

• Directly supervises examiners and clerical staff, including, but not limited to, monitoring attendance, job performance, evaluations and disciplinary issues. *
• Participates in new hire processes as needed (interviewing, training, Personnel Action Formks (PAF)). *
• Monitors daily staffing needs, ensures daily caseload staffing requirements are met and distributes caseloads as equitably as practical amongst direct reports.
• Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.*
• Performs file reviews to monitor accuracy and compliance with policies and laws. *
• Ensure consistent and accurate claim coding. *
• Prepares team meeting agenda and leads team meetings with direct reports. *
• Makes daily claims decisions as it pertains to claim strategies, action plans, handling of payments/recoveries, carrier/excess reporting and the like. *
• Runs supervisory reports as necessary to monitor performance and assist direct reports. *
• Reviews and approves reserve changes and payments within Company and Client guidelines. *
• 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, conducts and leads internal and external educational/training sessions for updated laws, policies, and procedures. *
• Responds to claimant and vendor concerns and facilitates timely resolution. *
• Evaluates vendor effectiveness and modifies vendor panels as needed within TRISTAR and account guidelines. *
• Ensure all staff adhere to client service instructions and applicable State reporting requirements. *
• Provides claims handling coverage during examiner absences and position vacancies. *
• Prepares, evaluates and analyzes monthly client reports. *
• Coordinates, facilitates and supports internal and external audits. *
• Participates in client file/claim reviews and addresses action items. *
• Partners with the corporate office and sales and service teams on requests for proposals (RFPs) and client service issues. *
• Adheres to TRISTAR’s Best Practices. *
• Performs other duties as assigned.

*Essential job function.

EQUIPMENT OPERATED/USED: Computer, 10-key, printer, copier, fax machine and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.

Qualifications

QUALIFICATIONS REQUIRED:

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

Knowledge, Skills and Abilities:

• Strong technical knowledge of multi-state workers’ compensation laws, regulations, and medical terminology.
• Ability to maintain a claims diary system, prioritize work, and meet strict deadlines.
• Strong analytical and problem-solving skills.
• Proficiency in Microsoft Word and Excel.
• Excellent written and verbal communication skills, including the ability to explain technical claims information clearly to claimants, clients, and staff.
• Ability to supervise, coach, and develop employees with varying levels of experience and technical ability.
• Strong interpersonal skills and the ability to maintain effective working relationships.
• Ability to manage competing priorities and remain effective under pressure.
• Ability to model a positive, professional attitude to direct reports.
• Ability to respond promptly to client requests and service needs.

Other Qualifications:

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

Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]

MENTAL AND PHYSICAL REQUIREMENTS

1. MENTAL EFFORT a. Reasoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. Solve practical problems; variety of variables with limited standardization; interpret instructions. X Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts.

b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; require theoretical application.

c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. Ability to compose original correspondence, follow technical manuals, and have increased contact with people. X Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.