Workers Compensation Claims Manager

Workers Compensation Claims Manager
May 24, 2019 dtric2

We are seeking a Workers Compensation Claims Manager to plan, direct, and maintain the workers compensation claims process from the inception of a claim to its resolution and closure, including delivery of exceptional customer service to employers and agencies.  This position will provide oversight of the unit by evaluating the performance of assigned adjusters, training, quality assurance, customer service, innovation, and staffing levels within assigned limits of authority that require a high degree of technical complexity and coordination; and provide technical expertise to manage vendor relations and process design.

Essential Functions:

  1. Manages a unit of workers compensation claims examiners in the performance of their daily activities, and ensures that claims are handled in compliance with Hawaii Revised Statutes and Workers Compensation Medical Fee Schedule.
  2. Develop, recommend and implement workers compensation claims handling policies and procedures.
  3. Writes and updates job descriptions of workers compensation claims examiners.
  4. Establishes and implements unit goals and operating plans to support the department and corporate objectives.
  5. Responsible for the selection and interviewing of prospective employees; identifying the best candidate for the position; and making salary and hiring recommendations.
  6. Responsible for development and evaluation of personnel, including providing and coordinating staff training and preparing and conducting performance evaluations.
  7. In conjunction with Human Resources and Vice President, Chief Claims Officer (where applicable) will conduct staff evaluations, counseling, and disciplinary action when necessary.
  8. Complete quarterly file reviews to evaluate file quality and adherence to established company standards; provide feedback to unit staff.
  9. Maintains record of hours, attendance, planned and unplanned personal time off of assigned staff, and records information onto payroll processing system.
  10. Reviews and audits claim files to ensure reserves are properly opened, reviewed for adequacy and appropriately closed.
  11. Supervise and direct litigation claim files with defense counsel and monitor legal expenses for same.
  12. Monitors for the efficient utilization of external resources, i.e. nurse case managers, independent field investigators, and independent medical bill reviewer.
  13. Reviews and approves Large Incurred Reports submitted by adjusters, for further review and approval by the Vice President, Chief Claims Officer.
  14. Ensures detailed claim information (DCI) is transmitted to NCCI with minimal errors.
  15. Handle internal/external complaints (both written and verbal), including Insurance Division inquiries; drafting an appropriate written response in conformance and/or compliance with company practice and/or statutory requirements of each case.
  16. Coordinates the presentations of prospective and newly acquired accounts to introduce DTRIC’s claims services at various locations including neighbor islands.
  17. Coordinate claim review meetings with insured, agencies/agents as necessary.
  18. Performs other related duties or special projects as may be required or assigned by Vice President, Chief Claims Officer.

Other Functions:

  1. Assist with handling claim files for adjusters on planned or unplanned PTO
  2. Scrutinize vendor contracts, including overseeing and maintaining compliance with contract terms and conditions.

Skills/Knowledge:

  1. Possess strong leadership skills with ability to prioritize, plan, and efficiently grow the unit
  2. Ability to effectively collaborate with internal and external business partners
  3. Ability to communicate well, orally and in writing, with internal and external customers
  4. Knowledge and applicability of relevant Hawaii Revised Statutes, and Workers Compensation Medical Fee Schedule
  5. Knowledge of Microsoft Office Suite and other business-related software

Education/Experience: 

  1. Associate’s or Bachelor’s degree required.
  2. Current and valid State of Hawaii Driver’s License with clean driving record
  3. Minimum three (3) years management experience
  4. Five (5) years experience adjusting property & casualty insurance claims may replace the Bachelor’s or Associate’s degree.
  5. Five (5) plus years experience adjusting workers compensation claims

As a DTRIC team member, you’ll enjoy a competitive salary, paid vacation and holidays, medical and dental coverage, 401(k) plan, preferred insurance rates, performance bonuses, and more.  We also have employee activities, wellness program and community service opportunities.