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ADP - Irvine, CA
posted 2 months ago
About the position
The Claims Lead Examiner at ADP is responsible for overseeing the workers' compensation program within the ADPTS/PEO structure. This role involves monitoring claims, resolving complaints, and collaborating with various stakeholders to ensure effective claims management and compliance with relevant laws and regulations. The position requires strong analytical skills to identify trends and implement corrective processes, as well as excellent communication skills to facilitate customer service and resolution of client issues.
Responsibilities
- Assist Claims Manager in monitoring the workers compensation program within the ADPTS/PEO structure.
- Review and resolve complaints raised by exterior business partners.
- Identify and track trends with specificity that could be problematic and take steps to develop processes to correct.
- Review and provide concurrence to T.P.A. for reserves, settlements, and other items per Special Service Instructions.
- Consistently consult and collaborate with T.P.A. and internal and external business partners.
- Ability to read data specific dashboards to orchestrate evaluation and analysis of claims to meet department and company goals.
- Monitor and ensure qualitative claim handling through T.P.A. and other vendor partners.
- Resolve escalated complaints and/or concerns by clients, risk and safety, H.R. and other internal business partners.
- Promotes interactive process and early return to work programs.
- Perform regular reviews of claims by specified criteria on diary.
- Provide regular reviews and provide feedback and recommendations for resolution of claim files as needed.
Requirements
- 7-10 years of workers compensation claims experience working in a client service/customer service environment rich with the use of state-of-the-art predictive modeling, and metrics, data analytic tools and HRIS and claims systems.
- Comprehensive knowledge of CA and western region state workers compensation administration, including applicable local, state and federal laws pertaining to WC insurance programs.
- Experience evaluating and recommending approval of claims reserves and settlements, designated expenditures and recovery forfeitures as needed.
- Bachelor's degree or equivalent in experience.
Nice-to-haves
- Comprehensive knowledge of western region states with general insurance policy coverage and state case laws.
- Understands the ins and outs of workers compensation claims within a PEO environment.
- Familiarity and use of Risktrac and Origami.
- Southern CA area ideal.
