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Unit Manager, Workers Comp (Claims Adjuster Sr Spec) Qual-Lynx

Plans, directs and guides the activities of a staff of adjusters in the investigation and settlement of claims to achieve timely, equitable and accurate claims processing and settlement value in a manner consistent with client expectations and which contributes to the profitability of the company.
Effectively supervise, lead, motivate, and provide direction to the unit adjusters and support staff.
Maintain a thorough knowledge of the litigation process and litigation management, an understanding of relevant jurisdictional laws and regulations, statutes and related revisions or changes in the law and apply to policies and procedures appropriately.
Oversee ongoing training, development and supervision of claims unit to ensure clearly defined responsibilities and standard performance.
Manage clients in the areas of claims administration and litigation through benchmarking, loss analysis and general performance measurement reports to ensure adherence to Best Practices, as well as company client specific claim program goals, directives, initiatives, policies and procedures.
Accept, review, provide initial handling recommendations and distribute new claims as they come into department.
Provide guidance to staff on coverage, liability and damage analysis, especially on severe and complex claims.
Provide oversight of all staff claims handling activities, including pursuit of subrogation, third party recoveries and application of credits and offsets.
Conduct and oversee all internal claim reviews and audits to ensure effective claims handling by adjusters.
Attend external client meetings to present PARs (payment authority request) and conduct claim and program reviews.
Attend court-related conferences, depositions, mediations, arbitrations and other meetings as needed.
Complete monthly audits on each adjuster.
Conduct monthly large loss meeting with unit staff.
Assist in hiring and training of new employees and ensure ongoing training in relevant areas.
Review time tracking and approve time off requests to ensure adequate staffing at all times.
Evaluate staff performance on an ongoing basis; responsible for performance reviews, goal setting and progressive discipline procedures to ensure a non-discriminatory and consistent work force.
Conduct or participate in client training and education externally as needed.
In a leadership role, participate in company projects/endeavors over and above unit/client-related supervisory functions.
Perform other duties as required.
Annually evaluate client contracts for costs savings and potential increases.
Take primary responsibility in drafting company responses to Proposals, RFQs/RFPs and/Contracts.
Provide all client related documents to appropriate staff and departments, including: client contact lists, coverage documents, risk management plans, client meeting schedule, defense panel list and authorized billing rates, excess reporting requirements, account protocols, changes to protocols and any other pertinent information needed to manage account.
Coordinate new client account set ups with involved staff, Client Services, Finance and IT.
Communicate all client and related program requirements, changes, additions and deletions to client programs to key internal personnel including but not limited to upper management, claims staff, IT, Client Services, Finance, etc.
Identify and take corrective actions for client concerns working with appropriate Claim Managers/Supervisors and other internal staff.
Handle any client emergencies, during business and occasionally, after hours and weekends as needed.
Notify client of staffing changes that impact the client's account.
Respond to and coordinate all client OPRA requests.
Annually prepare stewardship report for all managed accounts as required by the client.
Prepare and present training to clients.
Take primary responsibility in providing all data and reports for the Financial and/or Claims annual audits.
Travel on behalf of company and/or client, where needed to diverse geographical locations; attend state and national insurance and risk management conferences when requested or required by Upper Management.
Oversee ongoing training, development and supervision of claims unit to ensure clearly understood and defined account-related responsibilities and standard performance.
Manage clients in the areas of claims administration and litigation through benchmarking, loss analysis and general performance measurement reports to ensure adherence to best practices as well as company client specific claim program goals, directives, initiatives, policies and procedures.
Perform other duties as required.
Requirements include:
HS Diploma required; Bachelor's Degree strongly preferred
Minimum of 6 years of experience claims handling experience required
A minimum of 2-4 years people management experience strongly preferred
Expertise in Workers' Compensation and related claims handling practices and ability to apply
same.
Thorough understanding of managed care practices and ability to effectively apply same to obtain excellent claim results
Deep knowledge of client and carrier claims procedures
Substantial understanding of self-insured retention, excess and reinsurance reporting
Deep understanding of claims evaluations and exposure potential
Fluent in medical terminology and medical/injury treatments.
Must have expertise in principles of workers' compensation laws and applicable state and federal laws, including CMS and Medicare laws.
Must have proven expertise in litigation management.
Must possess outstanding customer service skills to interact effectively with clients, defense counsel, vendors, management and subordinates.
Excellent negotiation skills
Superior organizational and decision making skills
Strong analytical and strategizing skills
High proficiency in MS Office (Outlook, Word, and Excel)



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