Workers Compensation Claims Manager

TRISTAR RISK MANAGEMENT; Irving (TX); Sur place; USD 105 000 - 125 000; Plein temps

Résumé du poste

Paycom - ATS in Dallas–Irving, TX 75038 is seeking an experienced Claims Manager to lead the workers’ compensation claims unit under minimal supervision. You will oversee Claims Supervisors, Examiners, and Assistants, ensuring high-quality handling, compliance with laws, and strong client service.

You will provide operational leadership, guidance, and staff development while managing staffing, claims quality, financial controls, and relationships with clients.

Qualifications

• Experience in managing workers’ compensation claims operations.
• Strong leadership and staff development abilities.
• Knowledge of applicable laws and client-specific handling instructions.

Responsabilités

• Supervise Claims Supervisors, Examiners, and Assistants; coach and manage performance.
• Oversee claim handling, reviews, delays, denials, and time-sensitive decisions.
• Review and approve reserves, awards, and payments within authority.
• Conduct file reviews to ensure quality, documentation, and compliance.
• Coordinate staff training on laws, policies, and practices; deliver education sessions.
• Monitor workloads, coverage, and client service requirements; report monthly results.

Connaissances

Leadership

Staff development

Analytical skills

Supervisory experience

Customer service

Time management

Communication skills

Microsoft Word

Excel

Formation

High school diploma or GED

Bachelor's degree in related field (preferred)

Outils

Microsoft Word

Excel

Description du poste

Job Details: Level: Experienced, Job Location: Dallas - Irving, TX 75038, Position Type: Full Time, Education Level: High School Diploma or GED, Salary Range: $105,000.00 - $125,000.00 Salary/year, Travel Percentage: None, Job Shift: Day, Job Category: Admin - Clerical

POSITION SUMMARY

Under minimal supervision and reporting to the Area Manager, the Claims Manager manages and directs the operations of the workers’ compensation claims unit. This position oversees Claims Supervisors, Claims Examiners, and Claims Assistants to ensure high-quality claims handling, effective client service, and compliance with applicable state laws, company policies, Best Practices, and client-specific handling instructions.

The Claims Manager provides operational leadership, technical guidance, and staff development while overseeing staffing, claims quality, financial controls, and client relationships.

DUTIES AND RESPONSIBILITIES

• Supervises assigned Claims Supervisors, Claims Examiners, and Claims Assistants, including monitoring attendance, evaluating performance, providing coaching, and addressing disciplinary matters in partnership with Human Resources.*
• Oversee claims-handling activities, including initial and periodic reviews, delays, denials, and other time-sensitive claim decisions. *
• Review and approve reserve changes, awards, and payments within delegated authority levels, obtaining additional authority when required. *
• Conduct claim-file reviews to evaluate quality, documentation, reserve adequacy, and compliance with applicable laws, company procedures, and client requirements. *
• Coordinate and lead staff training on changes to applicable laws, policies, procedures, and claims-handling practices. *
• Coordinate, conduct, and document internal and external educational sessions.
• Monitor claim inventories, workloads, and staffing levels to ensure daily operational and client-service requirements are met. *
• Oversee and approve daily check runs and payment registers in accordance with established financial controls. *
• Respond to escalated claimant and vendor concerns and coordinate appropriate resolution. *
• Monitor vendor performance, service quality, and effectiveness. *
• Ensure adherence to client service instructions and Customized Handling Instructions.*
• Coordinate and provide claims-handling coverage during examiner absences and position vacancies. *
• Prepare, review, and evaluate monthly client reports for accuracy, completeness, and timely delivery. *
• Facilitate internal and external audits and oversee any required corrective actions. *
• Partner with the corporate office and sales/service team on requests for proposals (RFPs) and service-related matters.
• Attend client file reviews and address claims-handling questions, concerns, and recommendations.
• Provide account management for accounts without an assigned Account Manager. *
• Monitor branch expenses and review and approve invoices within delegated authority levels.
• Perform other duties as assigned.

EQUIPMENT OPERATED/USED

Computer and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING

Appropriate office attire when on video or attending client meetings.

Qualifications: QUALIFICATIONS REQUIRED

Education: High school diploma or GED required. Bachelor’s degree in a related field preferred. Five (5) to ten (10) years of related experience, or an equivalent combination of education and experience.

Knowledge, Skills, and Abilities

• Strong technical knowledge of workers’ compensation claims handling, applicable statutory and regulatory requirements, and medical terminology.
• Ability to manage diary systems, prioritize competing responsibilities, and meet strict deadlines.
• Strong analytical skills and sound judgment when reviewing complex claims and operational matters.
• Proficiency in Microsoft Word and Excel.
• Excellent written and verbal communication skills, including the ability to clearly convey technical information to claimants, clients, management, and staff.
• Ability to supervise and develop employees with varying experience and skill levels.
• Strong leadership and interpersonal skills.
• Excellent customer service skills and the ability to resolve escalated concerns professionally.
• Ability to monitor workloads, coordinate staffing, and maintain consistent quality and service standards.

Other Qualifications

N/A

Mental and Physical Requirements

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

MENTAL AND PHYSICAL REQUIREMENTS

1. MENTAL EFFORT

a. Reasoning 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.

Solve practical problems; variety of variables with limited standardization; interpret instructions.

X 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 addition 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; require 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.

Ability to compose original correspondence, follow technical manuals, and have increased contact with people.

X 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 EFFORT

a. Physical activity required to perform the job:

X 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.

Light work:

a. Exerting up to 20 pounds of force occasionally

b. Exerting up to 10 pounds frequently

c. 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 occasionally

b. Exerting up to 20 pounds of force frequently

c. Exerting up to 10 pounds of force constantly to move objects

Heavy work:

a. Exerting up to 100 pounds of force occasionally

b. Exerting up to 50 pounds of force frequently

c. Exerting up to 20 pounds of force constantly to move objects

Very heavy work:

a. Exerting in excess of 100 pounds of force occasionally

b. Exerting in excess of 50 pounds of force constantly to move objects

c. Exerting in excess of 20 pounds of force constantly to move objects

Visual requirements necessary to perform the job:

Far vision: clarity of vision at 20 feet or more

Near vision: clarity of vision at 20 inches or less

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 point

2. PHYSICAL EFFORT (cont.)

FREQUENCY

X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making find adjustments on machined parts.

Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.

X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers.

Frequently

Occasionally

3. WORKING CONDITIONS

WORKING CONDITION

ENVIRONMENTAL

FACTOR

NATURE/REASON

OF EXPOSURE

FREQUENCY

Dirt/Dust

Noise

Temperature extremes

Dampness

Vibrations

Equipment movement hazard

Chemicals/solvents

Electrical shock

Significant work pace/pressure

Odors/Fumes

Other (specify):