Claim Manager, Workers’ Compensation

This position requires strong interpersonal and communication skills (written and verbal), a high level of organizational effectiveness, and the ability to interface with senior management..

Some travel may be required.

General responsibilities may include:

• Participate in client training.
• Review/ approve settlement authority up to authority granted on assigned claims.
• Assist with off cycle reports as requested.
• Review/ approve reserves on assigned claims.
• Maintain client specific handling instructions, both internally and with TPA.
  • Ensure TPA compliance with same.
• Maintain diary on inventory of open and indemnity claims.
  • Ensure TPA compliance with our best claim practices.
  • Provide direction to TPA as needed.
  • Act as liaison between insureds and TPA as needed.
  • Review/ approve reserves on assigned claims.
  • Communicate with manager on claims above authority granted.
  • Review/ approve settlement authority up to authority granted on assigned claims.
• Ensure TPA compliance with our best claim practices.
• Participate in OR's Managed Care Excellence Group as requested.
• Provide direction to TPA as needed.
• Act as resource to clients in understanding/ implementing the MPN process.
• Act as liaison between broker, insured, UW, Loss Control and TPA.
• Prepare monthly client reports.
  • Assist with off cycle reports as requested.
• Obtain/ maintain GA adjuster’s license.
• Act as liaison between insureds and TPA as needed.
• Act as liaison to CA clients moving to/in the MPN.
  • Act as resource to clients in understanding/ implementing the MPN process.
• Communicate with manager on claims above authority granted.
• Participate in quarterly file reviews with TPA and audits as needed.
• Ensure TPA compliance with same.