Workers Compensation Claims Manager

Job Description

We currently have an exciting opportunity for a Workers Compensation Claims Manager to join our Risk Management team based in Plano, TX. This individual will be responsible for administering the insurance claims process for corporate-wide workers compensation with the objective of closing each claim fairly & quickly, and at the lowest possible cost. The Workers Compensation Claims Manager negotiates and maintains relationships with third party administrators. Also, develops, trains and monitors internal claims handling policies and procedures.

Responsibilities

• Administer and supervise the claims functions of corporate workers compensation for the Company to ensure effective and timely claims processing

• Coordinate and provide information and responses required by adjusters internally in order to adjust claim

• Oversee tracking of losses and provide monthly updates on open claims

• Develop guidelines and procedures for incident reporting and claims handling

• Approve payments and denials to claimants

• Compile, review, order or issue any necessary forms for compliance with applicable laws for workers compensation

• Gather and prepare information for submission to potential insurance carriers at the request of senior management

• Negotiate TPA Contracts and monitor service

• Coordinate and attend Claims Review Meetings

• Work with Legal Department on litigated claims and provide with appropriate documentation as required

• Support to DMs, RMs, RVPs and field personnel with training and support of claims handling process and procedure

• Prepare and analyze reports on monthly and quarterly basis

• Evaluate trends to support loss prevention

• Attend monthly P&L Meeting

• Review TPA and other vendor billings for accuracy

• Provide counsel and advice to management at all levels regarding workers compensation matters

• Interface with employees, managers, insurance carriers, medical personnel and attorneys regarding workers compensation claims, issues, questions and other related matters

• Oversee reporting of claims and compliance with state filing requirements

• Oversee medical utilization

• Review and analyze all claims; identify claims with potential exposure to high losses

• Coordinate with insurance carrier to create a structured action plan to reach cost effective resolution of claims

• Monitor claim activity and proper reserve practices by the TPA

• Participate in negotiations for claim settlements

• Schedule and coordinate periodic file reviews. Monitor follow through and completion of all action plans for reviewed claims

• Responsible for claims administration and calculation of statistics and maintenance of OSHA logs

• Work closely with claims adjusters, medical providers and various internal departments to reach claim resolution

• Assist in developing systems to track, monitor, audit and prepare reports regarding workers compensation

• Interpret laws and regulations, determine appropriate course of action and present solutions to resolve claims

• Maintain and develop knowledge of workers compensation regulations, laws and related Company policies and procedures

• Investigate accident and/or safety occurrences and review safety reports, taking appropriate action to ensure unsafe situations are resolved

• Research and resolve workers compensation related questions and/or problems

• Keep management informed on any issues or problems which may impact the operations of the Company

• Attend meetings, seminars and conferences with respect to workers compensation issues and concerns