Work Comp Claims Manager-TPA Oversight

Pharmacists Mutual Insurance has an opening for a Work Comp Claims Manager with TPA oversight. This position will ensure superior delivery of claims services and products. The manager will also direct, coordinate, and monitor the activities of a team of claims employees and/or other parties assigned to manage the Company's claims, such as Third-Party Administrators and MGAs. The manager will provide consulting and training resources and serve as a contact and technical resource to external and internal business partners. The AVP and VP levels of this position are promoted or hired on an approved and as needed basis.

Claims Manager

• Ensures timely and appropriate claim decisions and resolutions.
• Engages with the Claims team leadership to develop and implement strategic programs that meet our Company's goals and objectives.
• Assesses performance and growth needs of team members and engages in development discussions.

Essential Functions

Essential functions may include, but are not limited to the following:    

• Timely decision making and action to meet Company guidelines and goals.
• Provides quality customer service by monitoring performance and establishing metrics.
• Resolves complaints, problems, and coverage questions which have been escalated through the team.
• Establishes focus of the team to properly manage Company indemnity & expenses.
• Recommends appropriate cases for discussion for claims roundtable; Attends and/or presents at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expenses.
• Ensures that the Company’s claim quality, guidelines and metrics are successfully met.
• Assigns staff to attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
• Evaluates the work of assigned staff and prepares written performance evaluations; makes recommendations on personnel actions to include hiring, work assignments, training, and discipline.
• Manages relationships with large accounts and brokers from a claims and risk management perspective.
• Works with and manages a third party administrator and/or external business partners as applicable.

Knowledge, Skills and Abilities

• Understand principles and practices of insurance claims examination.
• Knowledge of employee management principles including hiring, supervision, training, retention, and performance evaluation.
• Conduct investigative interviews.
• Understand employee management and developing standards.
• Manage process, planning, and tracking of budgets.
• Correct English usage, spelling, grammar, vocabulary and punctuation.
• Ability and flexibility to work longer hours when workload fluctuations occur.
• Research and stay up-to-date with trends and changes in the claims/insurance industry.
• Communicate effectively with others (oral and written).
• Analyze complex issues and make critical decisions.
• Maintain records, prepare reports and conduct correspondence related to the work.
• Interpret and apply laws, rules and regulation, as well as complex policy and contract coverage.
• Obtain and use sensitive information discreetly and objectivel