Workers Compensation Claims Supervisor

Full-time - Manager

Jersey City, NJ

Insurance Carriers and Related Activities

About the position

Berkley Environmental is currently seeking a Workers Compensation Claims Supervisor. The Supervisor will be responsible for Oversight, Leading and Developing a staff of Technical WC Professionals handling claims across all 50 States. The team is responsible for Adjusting claims from end to end on Medical Only, moderate to catastrophic severity claims. The position can be filled in any of our offices (Atlanta, Boston, Irving, Walnut Creek, Chicago, Philadelphia, Jersey City). Key functions include but are not limited to the following: Responsible for oversight of team compliance with all Best Practices, as well as recruitment, performance and professional development. Ensure claims quality and service standards are met and Special Handling Instructions are followed. Produce updates and revisions of WC quality standards as warranted. Maintain proper WC Claims Service and support alignments. Collaborate with internal and external teams to include our medical team, and outside vendors, i.e., Defense Firms, MSA Vendors, Annuity firms and Vocational Rehab. Establish and implement annual goals and objectives for various claims initiatives, monitoring progress throughout the year. Ensure WC claims are properly adjudicated in accordance with company guidelines and quality standards using our QA program as a tool to gauge compliance. Analyze key performance indicators and other key metrics and make appropriate recommendations based on data. Monitor Recovery and Fraud operations, loss cost and expense strategy. Responsible for claim expense management (including litigation strategy and expense, IME, special investigation) and management of non-claim expenses for area of responsibility. Responsible for case load management, ensuring claims are appropriately reserved and for regulatory oversight for area of responsibility. Responsible for ensuring appropriate plans/workflows are in place to execute team/department initiatives. Coordinating with senior management to develop processes to assist with enhancing our service and loss cost strategies. Encourage quality standards and functional expertise throughout the unit. Ensure there is a focus on claim recoveries including but not limited to subrogation, second injury fund and Social Security offsets. Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients, i.e. MSAs and Annuities. Analyze team's complex claims by reviewing the investigation and gathering information to determine the exposure on the claim; supervise claims through well-developed action plans to an appropriate and timely resolution. Manage the litigation process; ensure timely and cost-effective claims resolution and settlement. Attend professional and medical conferences/meetings as necessary. May be responsible for own caseload in area of responsibility, depending on complexity.

Responsibilities

• Oversight of team compliance with all Best Practices.
• Recruitment, performance and professional development of staff.
• Ensure claims quality and service standards are met.
• Produce updates and revisions of WC quality standards.
• Maintain proper WC Claims Service and support alignments.
• Collaborate with internal and external teams including medical team and outside vendors.
• Establish and implement annual goals and objectives for claims initiatives.
• Ensure WC claims are properly adjudicated in accordance with company guidelines.
• Analyze key performance indicators and make recommendations based on data.
• Monitor Recovery and Fraud operations, loss cost and expense strategy.
• Responsible for claim expense management.
• Manage case load and ensure claims are appropriately reserved.
• Ensure appropriate plans/workflows are in place for team initiatives.
• Coordinate with senior management to enhance service and loss cost strategies.
• Encourage quality standards and functional expertise throughout the unit.
• Focus on claim recoveries including subrogation and Social Security offsets.
• Use cost containment techniques to reduce overall cost of claims.
• Analyze complex claims and supervise claims through action plans.
• Manage the litigation process for timely and cost-effective resolution.
• Attend professional and medical conferences/meetings as necessary.

Requirements

• 5+ years management experience preferred.
• Bachelor's Degree preferred.
• Investigating and adjusting Workers' Compensation claims experience required.
• Adjuster License required in area of adjusting specialty.
• Strong business acumen, analytical and decision-making skills.
• Extensive understanding of WC Statutory benefits and state regulatory requirements.
• Demonstrated strong written and oral communications skills.
• Strong Negotiation skills required.
• Demonstrated strong organizational skills including multi-tasking.
• Good working knowledge of Excel, Word, and general computer skills.
• Must be able to travel as necessary.

Benefits

• Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off.
• 401(k) and Profit-Sharing plans.
• Base Salary Range: $86,000 - $124,000.
• Eligible to participate in annual discretionary bonus.