Supervisor

Location: Oakland, CA | Job Type: Full-Time Responsibilities Provide technical and jurisdictional guidance and training to claims examiners and claims support staff. Conduct monthly quality reviews of claim files to measure claims management of examiners pursuant to client service instructions, contracts, audit requirements and industry’s best practices. Conduct periodic audits of measurable goals for claims assistants and clerical support staff. Provide sound and well‑developed recommendations to claims examiners on claim management, compensability issues, cost containment, litigation management, resolution and any sensitive issues as determined by the client. Interview, hire and establish performance assessments of the claims team by working with staff members to set measurable goals and job expectations, facilitate growth and development, monitor and provide documented performance history including 6‑month and yearly reviews. Identify problems and issues relating to claims and workflow management and present new office trends, ideas and recommendations to improve efficiency, production and quality of work products. Coordinate work projects relating to client needs. Analyze and review management reports and/or ad‑hoc reports and take appropriate action. Review appropriateness of reserve amounts over claims examiner autonomy. Provide guidance and establish workflows to prevent/avoid penalty exposure, including but not limited to self‑imposed increases due to untimely periodic indemnity payments and awards, administrative penalties as a result of failure to comply with the UR/IMR Process, LC 5814 penalty as a result of egregious claims actions, LC 5813 penalty due to frivolous and bad faith tactics, and penalties/interest due to a late payment of medical benefits. Monitor third‑party claims; maintain periodic review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client. Maintain contact with the client on claims and promote a professional client relationship; make recommendations to client as suggested by the claim status, and provide written responses per client’s needs. Assure that direct reports are properly licensed in the jurisdictions serviced. Administer company personnel policies in all areas and follow company staffing standards and training recommendations. Ensure data integrity by ensuring adequate documentation made by claims examiners; claim codes are accurately entered. Perform other duties as assigned. The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. Job Requirements of the WORKERS COMPENSATION CLAIMS SUPERVISOR Bachelor’s degree from an accredited college or university preferred. Self‑Insured Plan Certificate. 4850 experience are required. Current with required educational / training hours. Seven (7) years or equivalent combination of education and experience required to include two (2) years claims supervisor experience. Excellent oral and written communication skills including presentation skills. In‑depth knowledge of appropriate principles and laws pursuant to the California WC Laws Practices & Procedures, medical/disability management, SIU/Fraud, litigation rules, Medicare/CMS Rules and ethical issues. Thorough knowledge of claims management processes and procedures for public entities and agencies is a plus. PC literate including Microsoft office products. Detail oriented and strong organizational skills. Able to handle multiple tasks in a fast‑paced environment. Analytical and interpretive skills. Ability to work in a team environment, good interpersonal skills. Leadership/management and motivational skills. Excellent negotiation skills. Ability to achieve high performance standards and/or exceed Service Expectations. #J-18808-Ljbffr JT2