Workers' Compensation Claim Manager

2 months ago

Reading, United States CCMSI Full time

Overview:
At **CCMSI**, **we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.

**Reasons you should consider a career with CCMSI**:

- ** Culture**:Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
- ** Career development**: CCMSI offers robust internships and internal training programs for advancement within our organization.
- ** Benefits**: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
- ** Work Environment**: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.

As the **Claim Manager**, you will be responsible for investigating, adjusting, and supervising assigned claims within the specified region. This role entails overseeing and coordinating all claim staff and functions in the claims area. Additionally, this position serves as an advanced training role for potential promotion to higher levels of management.

**Responsibilities**:

- Review, assign and provide supervision of all claim activity for designated claims to ensure compliance with Corporate Claim Standards, client specific handling instructions and in accordance with applicable laws.
- Investigate, evaluate and adjust assigned claims in accordance with established claim handling standards and laws.
- Reserve establishment and/or oversight of reserves for designated claims within established reserve authority levels.
- Provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims. Negotiate any disputed bills or invoices for resolution, as appropriate.
- Authorize and make payments of claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
- Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
- Direct handling of designated litigated and complex claims.
- Provide education, training and assist in the development of claim staff.
- Review and maintain personal diary on claim system.
- Supervision of all claim activity for specified accounts.
- Attend account Board Meetings, conduct file review meetings and/or training sessions with clients, as requested.
- Attend and participate at hearings, mediations, and informal legal conferences, as appropriate.
- Performance appraisals and objective/goal setting and attainment of claim staff.
- Remain current on all legislative activity (both federal and state), industry and market trends to ensure that all staff members are appropriately informed and understand the impact of these developments.Develop revise and implement workflow processes to ensure efficiencies and provide oversight of individual caseloads, as appropriate.
- Monitor compliance with Corporate Claim Handling Standards and special client handling instructions statutes, rules and regulations, and relative case law.
- Performs other duties as assigned.

Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required.
- Excellent oral and written communication skills.
- Initiative to set and achieve performance goals.
- Good analytic and negotiation skills. Ability to cope with job pressures in a constantly changing environment.
- Knowledge of all lower level claim position responsibilities.
- Must be detail oriented and a self-starter with strong organizational abilities.
- Ability to coordinate and prioritize required.
- Flexibility, accuracy, initiative and the ability to work with minimum supervision.
- Discretion and confidentiality required.
- Reliable, predictable attendance within client service hours for the performance of this position.
- Responsive to internal and external client needs.
- Ability to clearly communicate verbally and/or in writing both internally and externally.

**Education and/or Experience**

Bachelor’s Degree or 15+ years claim experience.

Three years supervisory experience required.

**Computer Skills**

Proficient using Microsoft Office produc

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