Workers' Compensation Manager
About The Position
Must possess analytical skills and be able to work with a sense of urgency and accuracy. Must be able to adhere to multiple state workers’ compensation rules, regulations, and laws. Establish standards and procedures for all matters relating to the claims functions. Develop, maintain, and modify, when needed, effective procedures to ensure timely claims resolution maintaining a specialized base of knowledge regarding claims negotiation and settlement techniques. Must function as a resource to the injured teammates, leaders, and others with an interest in the claim. Acts as a resource to the Workers Compensation team on audit work, processes and other complex issues. Recommend reserves, settlements, or other actions. Ensuring that these actions meet company standards and the liability, damages, coverages, etc. have been rigorously evaluated. Provide proper and timely analysis of coverage including MMSEA (Medicare, Medicaid and SCHIP Extension Act) Reporting. Must be able to communicate with the injured teammate and other parties, as necessary. Monitor reserves and settlements associated with claims and provide appropriate reports as needed to leadership. Maintain claims data in such a manner that monthly reports for loss forecasting and trend analysis may be conducted. Assist leadership in evaluating excess policies to ensure the most favorable terms and conditions for the organization. Assist in the development, recommendation and/or implementation of loss prevention activities. Participate as needed in educational programs such as orientations to ensure awareness of the procedures associated with claims documentation and settlement. Must be able to provide additional support for all other duties as assigned.
Requirements
- Adjusters license required for area of responsibility as required by specific jurisdiction as applicable.
- Bachelor's degree in related field.
- Typically requires 5 years of experience with Workers Compensation claims administration.
- 10+ years of experience with Worker's Compensation claims administration will be considered in lieu of possessing a bachelor's degree.
- Excellent Oral and written communication skills, organizational skills, attention to detail, computer skills, and ability to manage multiple tasks required.
- Demonstrated proficiency in working with Microsoft Excel, Access, and PowerPoint required.
- Will limit access to protected health information (PHI) to the information necessary to do the job.
- Will share information only on a need-to-know basis for work purposes.
Nice To Haves
- Experience with RMIS Systems preferred.
Responsibilities
- Establish standards and procedures for all matters relating to the claims functions.
- Develop, maintain, and modify, when needed, effective procedures to ensure timely claims resolution maintaining a specialized base of knowledge regarding claims negotiation and settlement techniques.
- Function as a resource to the injured teammates, leaders, and others with an interest in the claim.
- Act as a resource to the Workers Compensation team on audit work, processes and other complex issues.
- Recommend reserves, settlements, or other actions, ensuring that these actions meet company standards and the liability, damages, coverages, etc. have been rigorously evaluated.
- Provide proper and timely analysis of coverage including MMSEA (Medicare, Medicaid and SCHIP Extension Act) Reporting.
- Communicate with the injured teammate and other parties, as necessary.
- Monitor reserves and settlements associated with claims and provide appropriate reports as needed to leadership.
- Maintain claims data in such a manner that monthly reports for loss forecasting and trend analysis may be conducted.
- Assist leadership in evaluating excess policies to ensure the most favorable terms and conditions for the organization.
- Assist in the development, recommendation and/or implementation of loss prevention activities.
- Participate as needed in educational programs such as orientations to ensure awareness of the procedures associated with claims documentation and settlement.
- Provide additional support for all other duties as assigned.
Benefits
- Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
- Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
- Benefits and more Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
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What This Job Offers
Job Type
Full-time
Career Level
Manager
