Workers Compensation Claims Supervisor

Workers Compensation Claims Supervisor

Hybrid Dallas - Irving, TX 75038

Salary Range $92,000.00 - $102,000.00 Salary/year Level Experienced Position Type Full Time Job Shift Day Education Level High School Diploma or GED Travel Percentage None Category Admin - Clerical

Workers Compensation Claims Supervisor

POSITIONS SUPERVISED: Directly: Claims Examiners, Claims Assistants; may supervise Administrative Support

POSITION SUMMARY: Under minimal supervision, oversees the daily operations of a workers' compensation claims unit, ensuring timely, accurate, and high-quality claims handling in compliance with applicable state laws, client requirements, and company policies and procedures.

Provides technical guidance, training, and performance oversight to assigned staff. Collaborates regularly with clients, management, Claims Examiners, and other TRISTAR staff across office locations to resolve claims and service issues.

DUTIES AND RESPONSIBILITIES:

• Monitors daily staffing needs and distributes caseloads as equitably as practical among direct reports.
• Reviews and approves priority payments and signs checks as authorized.
• Responds to claimant and vendor concerns and facilitates timely resolution.
• Evaluates vendor effectiveness and modifies vendor panels as needed within TRISTAR and account guidelines.
• Ensures staff follows client service instructions.
• Provides claims handling coverage during examiner absences and position vacancies.
• Prepares and evaluates monthly client reports.
• Coordinates and supports internal and external audits.
• Conducts and documents internal and external educational sessions.
• Participates in client file reviews and addresses resulting action items.
• Partners with the corporate office and sales and service teams on requests for proposals (RFPs) and client service issues.
• Adheres to TRISTAR's Supervisor Best Practice Guidelines.
• Performs other duties as assigned.

*Essential job function.

EQUIPMENT OPERATED/USED : Computer, 10-key, printer, copier, fax machine and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.

Qualifications

QUALIFICATIONS REQUIRED:

Education/Experience : Bachelor's degree in related field (preferred); five (5) plus years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities :

• Strong technical knowledge of Texas workers' compensation laws, regulations, and medical terminology.
• Ability to maintain a claims diary system, prioritize work, and meet strict deadlines.
• Strong analytical and problem-solving skills.
• Proficiency in Microsoft Word and Excel.
• Excellent written and verbal communication skills, including the ability to explain technical claims information clearly to claimants, clients, and staff.
• Ability to supervise, coach, and develop employees with varying levels of experience and technical ability.
• Strong interpersonal skills and the ability to maintain effective working relationships.
• Ability to manage competing priorities and remain effective under pressure.
• Ability to model a positive, professional attitude for direct reports.
• Ability to respond promptly to client requests and service needs.

MENTAL AND PHYSICAL REQUIREMENTS

1. MENTAL EFFORTa. Reasoning development:Follow one- or two-step instructions; routine, repetitive task.Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.Follow written, verbal, or diagrammatic instructions; several concrete variables.Solve practical problems; variety of variables with limited standardization; interpret instructions.X Logical or scientific thinking to solve problems; several abstract and concrete variables.Wide range of intellectual and practical problems; comprehend most obscure concepts.

b. Mathematical development:Simple additional and subtraction; copying figures, counting, and recording.Add, subtract, multiply, and divide whole numbers.X Arithmetic calculations involving fractions, decimals, and percentages.Arithmetic, algebraic, and geometric calculations.Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; require theoretical application.

c. Language development:Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.Ability to compose original correspondence, follow technical manuals, and have increased contact with people.X Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

2. PHYSICAL EFFORTa. Physical activity required to perform the job:X Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time.Light work:a. Exerting up to 20 pounds of force occasionallyb. Exerting up to 10 pounds of force frequentlyc. Exerting a negligible amount of force constantly to move objects(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).Medium work:a. Exerting up to 50 pounds of force occasionallyb. Exerting up to 20 pounds of force frequentlyc. Exerting up to 10 pounds of force constantly to move objectsHeavy work:a. Exerting up to 100 pounds of force occasionallyb. Exerting up to 50 pounds of force frequentlyc. Exerting up to 20 pounds of force constantly to move objectsVery heavy work:a. Exerting in excess of 100 pounds of force occasionallyb. Exerting in excess of 50 pounds of force constantly to move objectsc. Exerting in excess of 20 pounds of force constantly to move objects

Visual requirements necessary to perform the job:Far vision: clarity of vision at 20 feet or moreX Near vision: clarity of vision at 20 inches or lessX Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feetDepth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually areColor vision: ability to identify and distinguish colorsField of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point

2. PHYSICAL EFFORT (cont.) - FREQUENCY

c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.Kneeling: Bending legs at knee to come to a rest on knee or knees.Crouching: Bending the body downward and forward by bending legs and spine.Crawling: Moving about on hands and knees or hands and feet.Reaching: Extending hand(s) and arm(s) in any direction.Standing: Particularly for sustained periods of time.Walking: Moving about on foot to accomplish tasks, particularly for long distances.Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.Pulling: Using the upper extremities to extend force in order to drag, haul, or tug objects in a sustained motion.FootMotion: Using feet to push pedals.Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities