Claims Manager

Job Summary Reporting to the Executive Director of Healthcare & Benefits, the Claims Manager is responsible for overseeing the administration of the Workers’ Compensation and Unemployment Insurance programs as well as OSHA reporting compliance. This role establishes and maintains standards and procedures for claims “Best Practices” both internally and externally for all aspects of the programs. The Claims Manager provides leadership and guidance to a team of direct reports, develops and implements strategies to reduce and/or eliminate the financial exposure through accident and injury reduction, ensure timely response and compliance with Local, State, and Federal agencies regarding safety and environmental issues, and ensure liability coverage for the district. Responsibilities Oversee claims administration and vendor performance Provide oversight for the Third Party Administrators (TPAs) that manage the administration of the workers’ compensation and unemployment programs for all Chicago Public Schools employees Manage external vendors involved in the areas of claims administration, managed care, and litigation through benchmarking, loss analysis, and key performance indicators to ensure adherence to best practices as well as company specific claim program goals, directives, initiatives, policies, and procedures Conduct and oversee all claim reviews and audits to ensure effective claims handling by external adjusters Lead efforts in the CPOR and RFP process along with Procurement for the retention and renewal of selected vendors; ensure that vendor contracts meet necessary terms and conditions Stay up to date on claims assigned and team metric performance goals, providing guidance and course correction as necessary Authorize reserves and settlements within established authority Review and approve claim-related invoices, reconciliations, and payment requests within delegated authority Manage collection of required regulatory and company-specific claim related data to ensure compliance with all record keeping, reporting, loss forecasting, and loss analysis requirements for actuaries Manage Self-Insured claims programs to ensure administrative duties as well as all reporting and premium funding requirements are met Mitigate organizational risk through safety compliance and proactive loss prevention support Collaborate with internal and external business partners on policies and procedures for loss prevention and risk control Provide assistance and guidance to departments regarding liability, risk issues, and safety compliance Ensure compliance with federal and state safety regulations; coordinate and facilitate trainings including OSHA programs covering hazard assessment/personal protective equipment, Bloodborne Pathogens, and Workers Compensation Work closely with Facilities to conduct inspections of CPS locations in order to detect any safety and/or health hazards Participate in meetings and follow-up regarding actions and/or recommendations to the Executive Director for changes and safety practices, procedures, and/or Human Resource policy regarding employee safety Manage all OSHA compliance and reporting responsibilities to include distribution of OSHA 300 and 300A summaries to all schools and timely reporting to the Office of Labor Relations Maintain up-to-date knowledge of and manage departmental compliance with Medicare Medicaid SCHIP Expansion Act 2007 (MMSEA), Section 111 Manage handling of lawsuits involving worker’s compensation program and act as liaison with internal and external attorneys Coordinate employee benefit and leave of absence protocols Research and resolve employee inquiries about discrepancies with Workers’ Compensation benefits Collaborate with Payroll, the ADA Office, and other departments as needed on issues affecting compliance with all benefit plans, including projects related to collective bargaining agreements Provide excellent customer service to employees going out on leave of absence or requesting information about insurance, employment, and benefit entitlement Partner with the Leaves team for employees who are off work as a result of a work related injury to include the CPS assault leave Partner with the ADA team when appropriate to ensure correct protocol is followed as it relates to employee accommodations Supervise, develop, and manage the performance of a team of direct reports; provide leadership, guidance, and complete their performance reviews and goal setting Establish an annual workers’ compensation and unemployment budget, ensuring appropriate Purchase Orders are aligned; ensure timely payment of all vendor invoices and service fees Manage the full lifecycle of unemployment claims and administrative appeals Act as liaison between the unemployment claims handling vendor, CPS employees, Equal Opportunity Compliance Office (EOCO), Administration and school communities to gather supportive details needed to make sufficient determinations on separation claims Provide oversight of unemployment claims to ensure attendance at telephonic administrative hearings, preparing responses to grievances and maintaining required filings to the state of Illinois Work with UI vendor on audits and claims to file responses and protest after a complete and thorough investigation of all applicable facts Review all determination to approve the filing of 1st and 2nd level appeals Provide prep sessions and post-hearing consultations for hearings Perform other duties as assigned Qualifications Education Required Bachelor's degree from an accredited college or university is required Senior Claims Law Associate (SCLA), Associate in Risk Management (ARM), Chartered Property Casualty Underwriter (CPCU) or other claims/insurance designations, preferred Experience Required Minimum of five (5) years of Workers’ Compensation claims management and basic knowledge of Unemployment Insurance and HR Operations Minimum of two (2) years of supervisory experience managing a team of direct reports Solid experience managing relationships with TPAs, vendors, internal and external law firms Experience in public sector and unionized environments preferred Knowledge, Skills, and Abilities Strong knowledge of Illinois Workers Compensation Commission (IWCC) process, and Occupational Health and Safety Act (OSHA) Basic knowledge of state unemployment laws & regulations with the ability to learn quickly Excellent written and verbal communication skills, including presentations & facilitation of trainings to a wide variety of individuals Detail-oriented with strong communication, problem solving, critical thinking, and interpersonal skills required Knowledge of the PeopleSoft and Oracle system preferred Ability to articulate a vision, set high standards, and effectively lead team members in the realization of expectations set Demonstrate high levels of subject matter expertise, integrity, honesty, credibility, and the courage to make difficult yet necessary decisions Effective strategic planning capabilities, including the ability to establish long-term vision and goals, and align/manage activities toward goal fulfillment Strong leadership and team building skills, e.g. ability to develop high performing teams united around a clear vision for serving schools and achieving student success Knowledge of operations, budget/finance, management and organizational development Ability to build collaborative relationships with a variety of constituent groups, including external partners, to ensure the entire system operates in the most effective manner Ability to define problems, analyze data, and outline valid conclusions and action steps Benefits Health & Wellness: Your Care, Your Choice Medical Plan Options Pharmacy Vision Behavioral Health & EAP Employee Wellness Program Financial Security: Planning for Today and Tomorrow Basic Life Insurance Life and Disability Insurance Pension Plans Supplemental Retirement Plans (403(b) and 457(b)) Flexible Spending Accounts (FSAs) Spot Pet Insurance Work-Life Balance: Supporting Your Personal and Professional Life As a condition of employment with the Chicago Public Schools (CPS), employees are required to establish and maintain Chicago residency within six months of their CPS hire date and maintain residency throughout their employment with the district. The Chicago residency requirement does not apply to temporary/part-time positions; however, all CPS employees must be residents of Illinois. #J-18808-Ljbffr