Workers' Compensation Claims Manager, Texas

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 claims reserves, payments and denials

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

Review and provide input on TPA Contracts and other ancillary services and monitor service levels

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 a monthly and quarterly basis

Evaluate trends to support loss prevention

Attend monthly P&L Meeting & Workers’ Compensation Task Force Meetings

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 and third party administrators 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

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 continuing education with respect to workers compensation issues and concerns

Understands and operationalizes programs, policies, and procedures for: reporting, investigation, and analysis; litigation management; resolution/outcome management; and the delivery of claim information.

Has led and actively contributed to the successful integration and implementation of advanced technology solutions and innovative strategies within workers' compensation systems, resulting in enhanced efficiency, improved accuracy, streamlined processes, a better user experience, and strengthened system performance and reliability