Worker's Compensation Claims Supervisor

TRISTAR RISK MANAGEMENT; Rancho Cordova (CA); In loco; USD 100.000 - 110.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, Dental, Vision Insurance

Life and Disability Insurance

401(k) Plan

Paid Holidays

Paid Time Off

Referral bonus

Descrizione del lavoro

TRISTAR RISK MANAGEMENT in Sacramento/Rancho Cordova, CA, seeks an experienced Claims Supervisor to lead a dedicated claims unit and ensure quality results in compliance with state laws and client procedures.

Under minimal supervision, you will supervise examiners and staff, review claims issues, manage reserves, coordinate audits, and train staff to stay current with changes in regulations. Regular office presence and clear communication are essential.

Competenze

• Bachelor’s degree in a related field preferred; 3–5 years related experience or equivalent combination.
• Knowledge of statutory regulations affecting California.
• Excellent written and verbal communication skills; ability to convey technical details to claimants, clients, and staff.

Mansioni

• Directly supervise examiners and clerical staff, monitor attendance and performance.
• Review and address scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.
• Review and approve reserve changes, awards, and payments within Company and Client guidelines.
• Perform file reviews to monitor compliance with policies and laws.
• Establish supervisory diaries on claim files and complete pending diaries on schedule.
• Prepare for claim audits, review audit results, and provide rebuttal feedback.
• Coordinate and lead training sessions for staff on updated laws, policies, and procedures.
• Ensure daily caseload staffing requirements are met.
• Respond to claimant and vendor concerns and issues as needed.
• Ensure client service instructions are being adhered to.
• Attend client file-staffing meetings in person or telephonically.
• Other duties as assigned.

Conoscenze

Statutory regulations knowledge

Diary system prioritization

Analytical skills

Word/Excel proficiency

Written and verbal communication

People management

Formazione

Bachelor's degree in related field

Strumenti

Word

Excel

Descrizione del lavoro

Job Details: Level: Experienced, Job Location: Sacramento - Rancho Cordova, CA, Position Type: Full Time, Salary Range: $100000.00 - $110000.00Salary/year, Job Shift: Day, Job Category: Insurance,

POSITIONS SUPERVISED:

Directly supervise Claims Examiners and Claims Assistants; may provide oversight to File/Mail Clerks and Administrative Assistants as needed during the assignment.

POSITION SUMMARY:

Under minimal supervision, the Claims Supervisor manages and directs the activities of a dedicated claims unit, ensuring quality results and compliance with applicable state laws and company/client procedures. This assignment requires considerable interaction with the client, management, Claims Examiners, and other TRISTAR staff. Consistent attendance in the office, punctuality, and professional communication are essential to ensure continuity of operations during this leave coverage period.

DUTIES AND RESPONSIBILITIES:

• Directly supervise examiners and clerical staff. Includes monitoring attendance, job performance, evaluations, and disciplinary issues. *
• Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.*
• Reviews and approves reserve changes, awards, and payments within Company and Client guidelines. *
• Performs file reviews to monitor compliance with policies and laws.*
• 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 and leads training sessions for staff on updated laws, policies, and procedures.*
• Ensures daily caseload staffing requirements are met.*
• Responds to claimant and vendor concerns and issues as needed.*
• Ensures client service instructions are being adhered to.*
• Analyzes monthly client reports. *
• Facilitates internal and external audits. *
• Attend client file-staffing meetings in person or telephonically. *
• 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.

QUALIFICATIONS REQUIRED:

Education/Experience: Bachelor’s degree in related field (preferred); three (3) to five (5) years related experience; or equivalent combination of education and experience.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Technical knowledge of statutory regulations, including rules and procedures relating to California
• Ability to work on a diary system, prioritize tasks, and meet strict deadlines.
• Strong analytical skills.
• Proficient in Word and Excel.
• Excellent written and verbal communication skills, including the ability to convey technical details to claimants, clients, and staff.
• Ability to manage employees of various skill levels.
• Excellent interpersonal skills.

OTHER QUALIFICATIONS:

• Certifications and/or licenses as required by State regulation.

Here are some of the benefits you can enjoy in this role:

• Medical, Dental, Vision Insurance.
• Life and Disability Insurance.
• 401(k) Plan
• Paid Holidays
• Paid Time Off.
• Referral bonus.

Mental and Physical Requirements:

[see separate attachment for a copy of the checklist of mental and physical requirements]

MENTAL AND PHYSICAL REQUIREMENTS

1. MENTAL EFFORTa. Reoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables.X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems, several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts.b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers.X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.2. PHYSICAL EFFORTa. Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.X Light work:a. Exerting up to 20 pounds of force occasionallyb. Exerting up to 10 pounds frequentlyc. Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work:a. Exerting up to 50 pounds of force occasionallyb. Exerting up to 20 pounds of force frequentlyc. Exerting up to 10 pounds of force constantly to move objects Heavy work:a. Exerting up to 100 pounds of force occasionallyb. Exerting up to 50 pounds of force frequentlyc. Exerting up to 20 pounds of force constantly to move objects Very heavy work:a. Exerting in excess of 100 pounds of force occasionallyb. Exerting in excess of 50 pounds of force constantly to move objectsc. Exerting in excess of 20 pounds of force constantly to move objectsVisual requirements necessary to perform the job: Far vision: clarity of vision at 20 feet or moreX Near vision: clarity of vision at 20 inches or lessX Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point2. PHYSICAL EFFORT (cont.) FREQUENCYc. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs, andhands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.X Kneeling: Bending legs at knee to come to a rest on knee or knees.X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet.X Reaching: Extending hand(s) and arm(s) in any direction.X Standing: Particularly for sustained periods of time.X Walking: Moving about on foot to accomplish tasks, particularly for long distances.X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals.X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.X Grasping: Applying pressure to an object with the fingers and palm.OccasionallyFrequently3. WORKING CONDITIONSDisagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.'t\___________________WORKING CONDITIONENVIRONMENTALFACTORNATURE/REASONOF EXPOSUREFREQUENCYDirt/DustNoiseTemperature extremesDampnessVibrationsEquipment movement hazardChemicals/solventsElectrical shockSignificant work pace/pressureOdors/FumesOther (specify):Signatures:This job description has been approved by all levels of management:Human Resources: ____________________________Manager/Supervisor: ___________________________The employee's signature below constitutes the employee's understanding of the mental and physical requirements, essential functions, and duties of the position.Employe_____ Date_________