Regional Manager - Eastern Region Workers Compensation

Reports to: Head of TPA Claims

Summary/Objective: Oversees direct reports (6-7 Full Time direct reports) in determining coverage, compensability, benefits due; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; to identify subrogation of claims, clear and concise action plans, reserving and settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Review, assign and supervise all claim activity for designated claims to ensure compliance with company best practices, client specific handling instructions and in accordance with applicable laws.
• Responsible for oversight in assessing compensability, coverage, AWW/CR and timely payments.
• Reviews and approves settlement of claims within designated authority.
• Responsible for overseeing reserve establishment and/or oversight of reserves for designated claims within established reserve authority levels.
• Monitors necessary state filings within statutory limits.
• Oversees the litigation process; ensures timely and cost-effective claims resolution.
• Reviews vendor referrals utilized in investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Monitors and approves claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate for further review.
• Leads team manager meetings and assigns accountability for follow-up items.
• Mentors and provide ongoing training and assist in the development of claim staff.
• Review and maintain supervisory diary on claim system.
• Ovrseeing of all claim activity for specified accounts.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
• Key part of the team with Team Manager/Lead to interview adjusters and provide feedback.
• Provides assistance/support to Team Manager/Lead with monthly review of adjusted workloads; notes trends and suggests adjustments when necessary.
• Participates in claim reviews both telephonic and in person as needed.
• Participates in onsite meetings with insureds.
• Collaborates with adjuster, team managers, insureds, and brokers on a regular basis.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others.
• Supports the organization and management.
• Some travel may be required.

QUALIFICATIONS

Preferred Education and Experience

Bachelor’s Degree (preferred), or equivalent experience (8-10 yrs) of adjusting experience. Knowledge in multi-state jurisdiction, is a plus. Also willing to learn additional jurisdictions. Ability to multitask, organize, prioritize, handle a fast-paced environment, and manage workload with a positive attitude and minimal supervision. Strong written and verbal communication skills, as well as attention to detail. Professional certifications as applicable to line of business is a plus.

Skills & Knowledge

• In-depth knowledge of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent negotiation skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

Competencies

Thoroughness. Technical Capacity. Problem Solving.

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands

The physical demands described here are representative of those that must be met by an employee