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Role Description

The Director, Workers’ Compensation Claims is responsible for oversight of the day-to-day performance of the business team claims adjusters, return-to-work specialists, and nurse case managers. This position’s objective is to provide leadership that assures superior, cost-effective service and compliance with adopted best claims practices, and loss control practices if applicable, to eliminate unwarranted loss.

• Supervise claims management activities for the business team members.
• Ensure that new policyholders are properly on-boarded. Track these results using Encova systems.
• Evaluate and assign claims to team adjusters, following proper protocols.
• Provide guidance to assist with identification of possible complications related to developing injury/exposure claims.
• Assure establishment of appropriate reserve values throughout the life of the claim. Approve and adjust reserves as necessary.
• Consult with internal/external medical, legal, and vocational professionals on current and/or recommended treatment, litigation or rehabilitation plans to assist the adjuster in reaching achievable and appropriate claim outcomes.
• Analyze medical, legal and vocational rehabilitation reports compared to established guidelines. Advise staff on findings outside of established guidelines.
• Supervise and assist business team claims staff with investigation, evaluation and settlement of assigned claims through application of technical knowledge and human relation skills to effect fair and prompt claim closure and to contribute to a reduced loss ratio.
• Support and assist claims staff with the investigation and pursuit of subrogation recoveries.
• Participate in claim discussions at team staffing. Provide guidance when needed.
• Represent the organization on special projects; carry out speaking engagements for local meetings or conferences.
• Train and mentor new associates on claims and unit procedures.
• Work collaboratively with team adjusters, outside counsel, injured employee, employer, health and rehabilitation professionals to manage claim costs, promote quality medical care and timely return-to-work (RTW) to achieve optimum cost-effective medical and vocational outcomes.
• Perform file reviews for claims staff as part of the Quality Assurance program to assure that claims are being handled in accordance with the company’s set best practices.
• Facilitate meetings with policyholders, both independent of and in concert with the Business Director.
• Work collaboratively with Claims Operations and the Best Practice Leader on projects involving claim policies, procedures and best practices.
• Identify, develop, and analyze claims-related reports to assist and advise the Business Director of current and future profitability outcomes.
• If SLC oversight is part of responsibility, perform periodic ride-alongs with SLC Specialists to ensure proper loss prevention and mitigation is being delivered to Encova customers.
• If SLC oversight is part of responsibility, participate in SLC performance review conversations with the Business Director.

Qualifications

• Bachelor’s degree from an accredited college or university preferred.
• Five years of insurance experience with a private carrier, former workers’ compensation commission, agency or third-party administrator required.
• Preference may be shown to a candidate with multiple state insurance experience.
• Preference may be shown to a candidate with claims adjusting, case management, or safety and loss control experience.
• Preference may be shown to a candidate with previous managerial experience.
• Must hold or be eligible to obtain an adjuster’s license in applicable states.
• Must pass the claims adjuster license exam(s) for applicable states within six months of being hired.
• Demonstrate the ability to motivate people toward a common goal.
• Proven record of providing support as mentor and resource for fellow team members.
• Proven record of effective communication.
• Advanced knowledge of workers compensation insurance practices, statute, precedents and government regulations.
• Understand the implications of both current and future decisions.
• Combine pieces of information to form general rules or conclusions.
• Uses logic and reasoning to identify strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
• Can translate and explain the meaning of information presented and how that information may be used to effectively make decisions and develop strategies.
• Can evaluate relative costs and benefits of potential actions to choose the best action.
• Can bring parties together to reconcile differences.
• Effectively manages time without direct supervision.
• Use relevant information and expertise to determine whether events or processes comply with laws, regulations or standards.
• Analyze information and evaluates results to choose the best solution.
• Identify complex problems and reviews related information to develop and evaluate options and implement solutions.
• Work effectively in a team environment.
• Able to arrange items or actions in a certain order or pattern according to a specific rule or set of rules.
• Understand how claim costs affect loss ratios, the overall profitability of an account and ultimately, a book of business.
• If SLC oversight is part of responsibility, understand how claim, incident and near miss frequency impacts future loss activity and ultimately the profitability of an account/book of business.
• Ability to work effectively in a paperless environment.

Benefits

• Health, Dental & Vision Insurance
• Company-provided life and income protection plans
• Eligibility to participate in a company incentive bonus program
• 401(k) Retirement Plan - 100% company match up to 7% on annual salary
• Paid Time Off, Paid Holidays, and Floating Holidays
• Flexible Work Arrangements - Hybrid and remote depending on the role