Workers Compensation Claims Supervisor

POSITION SUMMARY: Under minimal supervision, oversees the daily operations of a workers’ compensation claims unit, ensuring timely, accurate, and high-quality claims handling in compliance with applicable state laws, client requirements, and company policies and procedures.

Provides technical guidance, training, and performance oversight to assigned staff and regularly interacts and collaborates with clients, management, Claims Examiners, and other TRISTAR personnel to resolve claims and service issues.

DUTIES AND RESPONSIBILITIES:

• Directly supervises examiners and clerical staff, including, but not limited to, monitoring attendance, job performance, evaluations and disciplinary issues. *
• Participates in new hire processes as needed (interviewing, training, Personnel Action Formks (PAF)). * 
• Monitors daily staffing needs, ensures daily caseload staffing requirements are met and distributes caseloads as equitably as practical amongst direct reports.
• Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.*
• Performs file reviews to monitor accuracy and compliance with policies and laws. *
• Ensure consistent and accurate claim coding. *
• Prepares team meeting agenda and leads team meetings with direct reports. *
• Makes daily claims decisions as it pertains to claim strategies, action plans, handling of payments/recoveries, carrier/excess reporting and the like. *
• Runs supervisory reports as necessary to monitor performance and assist direct reports. *
• Reviews and approves reserve changes and payments within Company and Client guidelines. *
• Establishes appropriate supervisory diaries on claim files and completes pending diaries on or before scheduled due dates. *

• Prepares for claim audits, reviews audit results, and provides appropriate rebuttal feedback. *
• Coordinates, conducts and leads internal and external educational/training sessions for updated laws, policies, and procedures. *
• Responds to claimant and vendor concerns and facilitates timely resolution. *
• Evaluates vendor effectiveness and modifies vendor panels as needed within TRISTAR and account guidelines. *
• Ensure all staff adhere to client service instructions and applicable State reporting requirements. *
• Provides claims handling coverage during examiner absences and position vacancies. *
• Prepares, evaluates and analyzes monthly client reports. *
• Coordinates, facilitates and supports internal and external audits. *
• Participates in client file/claim reviews and addresses action items. *
• Partners with the corporate office and sales and service teams on requests for proposals (RFPs) and client service issues. *
• Adheres to TRISTAR’s Best Practices. *
• Performs other duties as assigned.

*Essential job function.

EQUIPMENT OPERATED/USED: Computer, 10-key, printer, copier, fax machine and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.