Reports directly to the Claims Manager. Under the direction of the Claims Manager, is responsible for the overall work product of a claims unit comprised of Claims Specialists who manage assigned inventories of claim files. The unit also includes Claims Assistants who are responsible for providing clerical support to the Claims Specialists. The nature of the work involves coaching and counseling, monitoring work performance to assure compliance with company standards and Labor Code rules and regulations, conducting performance evaluations, and instituting corrective action when appropriate.
Essential Duties and Responsibilities:
Responsible for the timely completion of performance reviews for all personnel within the assigned unit.
Provides monetary approval authority up to assigned authority level.
Maintains selected files on personal diary including all files reserved over $50,000, all subrogation files, all files with delayed or denied benefits, all files formally assigned to the SIU, and all files with unresolved coverage issues.
Upon request or in accordance with the applicable claims handling contract provides all information, reports, records, logs, and other information our clients may require.
Provides ongoing advice, mentoring, coaching, counseling and performance feedback to all personnel in assigned unit.
Responsible for assuring that all claims are handled in accordance with applicable statutes and company rules.
Deals quickly and decisively with personnel issues as they arise and keeps the manager informed with regards to the need for or the progress of any corrective action activities.
Exhibits a knowledgeable and helpful attitude and projects a professional image on behalf of the company.
Identifies and develops at least one individual to serve as supervisor backup.
Performs quarterly audits of 10% of the open inventory of each claims specialist for the purpose of validating the accuracy and completeness of the claims management process as well as to identify opportunities for improving the process as well as the claim result.
Responsible for insisting upon a spirit of teamwork and cooperation between claims personnel in assigned unit and the personnel of other departments.
Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them.
Handles other duties and tasks as deemed appropriate by the Claims Manager.
Requirements
Job Requirements:
Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.
Change Management - Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results.
Leadership - Exhibits confidence in self and others; Inspires and motivates others to perform well; Effectively influences actions and opinions of others; Inspires respect and trust; Accepts feedback from others; Provides vision and inspiration to peers and subordinates; Gives appropriate recognition to others; Displays passion and optimism; Mobilizes others to fulfill the vision.
Managing People - Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Makes self available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products and services; Continually works to improve supervisory skills.
Qualification Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience:
Bachelor's degree (B. A.) from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience. Five or more years of progressive technical claim experience, demonstrating a high degree of judgment and discretion, is capable of providing adequate guidance on complex claim cases and can negotiate settlements effectively.