Join a growing insurance organization where collaboration, professional development, and exceptional service are at the heart of everything they do!
Responsibilities and Accountabilities
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Must hold valid California adjusters license.
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Direct the handling of workers’ compensation claims across multiple states while coordinating the assignment and distribution of new claims as the team grows.
- Lead and support the claims team by providing technical oversight, guidance, and quality review throughout the life of each claim.
- Analyze claim exposure and authorize reserve changes in accordance with company policies, regulatory requirements, and established timelines.
- Ensure all claim activity is thoroughly documented and accurately maintained within the claims management system.
- Verify the accuracy of claim coding, financial information, and data integrity in electronic claim files and the Origami system.
- Regularly assess claim developments and adjust reserves, strategies, and action plans as warranted by new information.
- Review, authorize, and oversee settlement strategies, negotiation efforts, and claim resolution plans within delegated authority.
- Oversee hearing schedules and tracking processes to ensure deadlines are met and no legal proceedings are missed.
- Monitor the performance of defense counsel, medical providers, investigators, and other external vendors to ensure quality service and cost-effective claim management.
- Partner with legal counsel by providing documentation, claim analysis, and strategic support during litigation.
- Manage vendor utilization by reviewing and approving assignments to ensure appropriate expense control.
- Identify and pursue subrogation opportunities to maximize recovery from responsible third parties.
- Exercise sound judgment and analytical reasoning to evaluate complex claim issues, develop solutions, and make informed claim decisions.
- Conduct routine file audits to measure claim quality, compliance, and adherence to departmental performance expectations.
- Prepare and deliver annual performance reviews that accurately reflect employee contributions and development needs.
- Address and document employee performance concerns in accordance with Human Resources policies and company procedures.
- Keep leadership informed of significant claim issues, operational challenges, and emerging trends requiring management attention.
- Promote teamwork by building positive working relationships across departments and contributing to a collaborative work environment.
- Demonstrate professionalism by remaining adaptable, receptive to feedback, and committed to continuous improvement.
- Provide oversight and performance management of Third-Party Administrator (TPA) operations to ensure service standards are achieved.
- Facilitate onboarding, training, coaching, and ongoing development of new and existing claims personnel.
- Perform additional responsibilities and special assignments in support of departmental and organizational objectives.
- Serve as a subject matter expert with advanced knowledge of workers’ compensation claims handling, regulatory compliance, and industry best practices at the national level.
- Ensure claim handling practices remain compliant with applicable insurance laws, regulations, company policies, and internal guidelines.
- Foster a culture of integrity, accountability, and ethical decision-making in all aspects of claims management.
- Work closely with the Claims Manager, Director of Claims, and Vice President of Claims
Interested or know someone who might be? Reach out to: [email protected] or (646)-349-0114
