Workers Compensation Claims Supervisor

Overview

Fresno Office - Fresno, CA 93727

Salary Range: $ - $ Salary/year

Position Type:
Full Time

Job Shift:
Day

Education Level:
High School Diploma or GED

Travel Percentage :
Negligible

Category:
Insurance

Workers Compensation Claims Supervisor

This position requires considerable interaction with the client, management, other Claims Examiners, and other TRISTAR staff in the office; therefore, consistently beginning work, in a timely manner, is inherently required of this position.

• Directly supervise examiners and clerical staff. Includes monitoring attendance, job performance, evaluations, and disciplinary issues.
• Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.
• Reviews and approves reserve changes, awards, and payments within Company and Client guidelines.
• Performs file reviews to monitor compliance with policies and laws.
• 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 and leads training sessions for staff on updated laws, policies, and procedures.
• Ensures daily caseload staffing requirements are met.
• Responds to claimant and vendor concerns and issues as needed.
• Ensure client handling instructions are being adhered to.
• Analyzes monthly client reports.
• Facilitates internal and external audits.
• Attends client file-staffing meetings in-person or telephonically.
• Other duties as assigned.

Essential job function.

Computer, 10-key, printer, copier, fax machine and other office equipment.

Appropriate office attire.

QUALIFICATIONS

REQUIRED:

Education/

Experience:

Bachelor’s degree in related field (preferred); three (3) to five (5) years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities:

• Technical knowledge of statutory regulations.
• Ability to work on a diary system, prioritize tasks and meet strict deadlines.
• Strong analytical skills.
• Proficient in Word and Excel.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
• Ability to manage employees of various skill levels.
• Excellent interpersonal skills.

Other

Qualifications:

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

Mental and

Physical Requirements:

[see separate attachments attached for a copy of checklist of mental and physical requirements]

1. MENTAL EFFORT

a. Reasoning development:

• Solve practical problems; variety of variables with limited standardization; interpret instructions.
• 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:

• Add, subtract, multiply, and divide whole numbers.
• Arithmetic calculations involving fractions, decimals, and percentages.

c. Language development:

• Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
• 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.

2. PHYSICAL EFFORT

a. Physical activity required to perform the job:

Sedentary work:
Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

• Light work:
  Exerting up to 20 pounds of force occasionally
• Exerting up to 10 pounds frequently
• Exerting a negligible amount of force constantly to move objects
• Medium work:
  Exerting up to 50 pounds of force occasionally
• Exerting up to 20 pounds of force frequently
• Exerting up to 10 pounds constantly to move objects
• Heavy work:
  Exerting up to 100 pounds of force occasionally
• Exerting up to 50 pounds of force frequently
• Exerting up to 20 pounds of force constantly to move objects
• Very heavy work:
  Exerting an excess of 100 pounds of force occasionally
• Exerting in excess of 50 pounds of force constantly to move objects
• Exerting in excess of 20 pounds of force constantly to move objects

Visual requirements:
Far vision, Near vision, Mid-range vision, Depth perception, Color vision, Field of vision.

Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.

N/A

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