Director of Workers' Compensation Claims

Position Summary

This role primarily oversees, monitors and provides technical and supervisory guidance to the workers’ compensation claims team in their day-to-day activities as well as coordinating with our TPA, insurance carriers, claimants, defense counsel and internal stakeholders. Ensures compliance with regulatory and statutory requirements and standards of performance in accordance with corporate objectives. Additionally, this role requires the technical ability gather and utilize data to analyze workers’ compensation claim costs and trends.

In addition to Claims oversight responsibilities, this position requires the technical ability to gather and utilize data to analyze workers compensation claim costs and trends as well as produce reports necessary to recommend, defend, and implement new claims processes, as needed. Participation in the Company’s annual workers’ compensation program renewal is expected, as is the ability to translate the claims results via Artificial Intelligence tools and other methods into summaries to be utilized by the Company’s Finance team in the preparation of Financial Statements. On occasion, this position may be tasked with evaluating our TPA relationship, gathering information on alternatives, and recommending TPA strategy to Executive Management.

Essential Job Functions

• Work closely with the VP of Risk Management on the claims process ensuring compliance with regulatory requirements, company best practices and policies and industry standards

• Ensure compliance with carrier requirements and claims management protocols

• Provide direction and supervision to the workers’ compensation claims team through daily interaction identifying activity goals and supporting the team in achievement

• Identify and participate in training and developmental needs of current staff through coaching and mentoring; assist with hiring and training new employees; prepare performance evaluations and suggest merit increase recommendations for direct reports

• Coordinate and conduct claim file reviews and audits including input related to action plans and monitoring of plan to closure

• Work closely with adjusters and attorneys on claim resolution strategies and settlement agreements

• Manage TPA and vendor activity ensuring a high level of service is maintained and the company’s best interests are contemplated

• Maximize utilization of company cost containment programs; return-to-work, drug testing, and timely claims reporting

• Review and provide concurrence on reserve increases

• Oversee and manage carrier information systems, data integrity, and analytical reports used to measure and manage the claims function

• Maximize the use of carrier and TPA systems for data management and reporting through learned functionality and ensure the internal claims team is familiar with all technical capabilities of any system utilized

• Prepare and distribute claims reports as required (weekly/monthly/quarterly/annually) including assistance with development of senior level reports to measure overall claims management performance

• Review claims data and reports for potential closures, reserve adequacy, settlement opportunity and other financial aspects making assignments as appropriate to team members for follow up

• Collaborate with other departments/teams including Client Services, Payroll, Legal, Safety, Risk Operations, Underwriting, and the internal P&C agency

• Continually evaluate all processes and procedures to ensure a high level of efficiency and effectiveness

• Maintain quality of service and accountability standards with all internal and external partners

• Communicate with staff, clients, employees, attorneys and others in a timely and professional manner

Skills and Experience

• Minimum 10+ years of experience handling complex and litigated workers’ compensation claims

• Minimum 5+ years of implementing and maintaining effective compliance of federal and/or state regulations

• Bachelor’s degree strongly preferred – combination of college and/or professional certifications will be considered. Master of Business Administration or equivalent senior-level experience preferred, including All Lines Adjusters License

• Working knowledge of commercial insurance claim operations, both as an employer and for clients of the Agency

• Ability to lead, train, mentor and coach employees

• Excellent verbal and written communication skills

• Demonstrates adjusting, negotiating skills and a thorough knowledge of state laws and regulations

• Strong time management, prioritization, organizational skills, and the ability to multi-task

• Experience working with carriers, brokers, third-party administrators, managed care organizations and medical providers

• Ability to work well independently and as part of an overall team

• Strong knowledge of AI tools to gain understanding and develop action plans around claims results and other Risk Management opportunities

• Ability and experience presenting ideas in Executive or Board level meetings, and with Executive level employees of insurance carriers and brokers

• Demonstrated ability to gather facts, make recommendations, and present those recommendations to Executive Management

• Working knowledge of Corporate Finance and Accounting and the impact of WC results on the Company’s overall financial position

• PEO experience strongly preferred

About CoAd

CoAd is a leading HCM organization providing payroll, benefits administration, HR compliance, workforce management, and full-service PEO and ASO services to more than 16,000 clients nationwide. Through our technology, CoAd delivers technology-enabled solutions that support employers and worksite employees across the United States.

EEO

CoAdvantage is committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, national origin, ancestry, citizenship status, age, sex (including pregnancy, childbirth, breast feeding and pregnancy-related medical conditions), gender, gender identity or expression, sexual orientation, marital status, uniform service member and veteran status, disability, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances.