What are the responsibilities and job description for the Liability Claims Manager position at Tristar Insurance?
POSITION SUMMARY: Under minimal supervision, manages and directs the activities of a claims unit to ensure high-quality claim handling, client service excellence, and compliance with applicable state laws, regulations, and company policies and procedures.
DUTIES AND RESPONSIBILITIES
- Directly supervises Claims Examiners and Claims Assistants, including monitoring attendance, performance, coaching, performance evaluations, and disciplinary matters.
- Reviews and addresses scheduled claim activities, including initial reviews, periodic reviews, delays, denials, and other claim-related issues.
- Reviews and approves reserve changes, settlements, awards, and payments within authority limits.
- Conducts file reviews to ensure compliance with company policies, client requirements, and applicable laws and regulations.
- Coordinates, conducts, and documents training sessions related to legislative changes, company procedures, and best practices.
- Conducts and documents internal and external educational sessions.
- Ensures appropriate staffing levels are maintained to support workload demands and service expectations.
- Supervises and approves daily check runs and payment registers.
- Responds to claimant, client, and vendor concerns and resolves issues as appropriate.
- Monitors vendor performance and effectiveness to ensure service quality and compliance.
- Ensures client service instructions and account-specific requirements are consistently followed.
- Provides operational coverage for examiner vacancies resulting from vacations, leaves of absence, or open positions.
- Prepares, reviews, and evaluates monthly client reports and management information.
- Facilitates internal, external, and client audits.
- Partners with Corporate Operations, Sales, and Client Services teams in support of RFPs, implementations, and client service initiatives.
- Participates in client claim reviews and stewardship meetings.
- Provides account management support for accounts that do not have an assigned Account Manager.
- Monitors branch expenses and approves invoices and related expenditures in accordance with company guidelines.
- Performs other duties as assigned.
*Essential Job Function
Equipment Operated/Used
Computer, calculator, printer, copier, scanner, telephone, and other standard office equipment.
Special Equipment or Clothing
Appropriate business attire as required by company policy
Qualifications:QUALIFICATIONS REQUIRED:
Education and Experience
- High School Diploma or GED required.
- Bachelor’s degree in business administration, Risk Management, Insurance, or a related field preferred.
- Five (5) to ten (10) years of progressively responsible claims management or claims handling experience.
- Equivalent combinations of education and experience may be considered.
Knowledge, Skills, and Abilities
- Strong technical knowledge of liability claims handling, statutory regulations, and medical terminology.
- Ability to effectively manage multiple priorities, work within a diary system, and meet strict deadlines.
- Strong analytical, problem-solving, and decision-making skills.
- Proficiency in Microsoft Office applications, including Word, Excel, Outlook, and Teams.
- Excellent written and verbal communication skills, including the ability to communicate complex claim matters to clients, claimants, vendors, and staff.
- Demonstrated leadership and employee development skills with the ability to manage individuals with varying levels of experience and expertise.
- Strong interpersonal and relationship-building skills.
- Excellent customer service and client management skills.
- Ability to maintain confidentiality and exercise sound judgment in sensitive situations.
Here are some of the benefits you can enjoy in this role:
- Medical, Dental & Vision insurance
- Life & Disability Insurance
- 401(k) plan
- Paid time off
- Paid holidays
- Referral Bonus
Mental and Physical Requirements
See the separate Mental and Physical Requirements Checklist.
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MENTAL AND PHYSICAL REQUIREMENTS |
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. |
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; requires theoretical application. |
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. |
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. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
X Light work:
(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:
Heavy work:
b. Exerting up to 50 pounds of force frequently
Very heavy work:
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Far vision: clarity of vision at 20 feet or more
X Near vision: clarity of vision at 20 feet or less
X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision: the ability to identify and distinguish colors
Field of vision: the ability to observe an area up or down or to the right or left while eyes are fixed on a given point
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FREQUENCY |
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 type of climbing required exceed those 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 type of balancing exceed those needed for ordinary locomotion and the maintenance of body equilibrium.
X Stooping: Bending the body downward and forward by bending the 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.
X Kneeling: Bending legs at the knee to come to a rest on the knee or knees.
X Crouching: Bending the body downward and forward by bending legs and spine.
Crawling: Moving about on hands and knees or hands and feet.
X Reaching: Extending hand(s) and arm(s) in any direction.
X Standing: Particularly for sustained periods of time.
X Walking: Moving about on foot to accomplish tasks, particularly for long distances.
X Pushing: Using upper extremities to press against something with steady force to thrust forward, downward, or outward.
X Pulling: Using upper extremities to exert force to drag, haul, or tug objects in a sustained motion.
Foot Motion: Using feet to push pedals.
X 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 and back muscles.
X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm, as in handling.
X Grasping: Applying pressure to an object with the fingers and palm.
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Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Frequently
Frequently
Occasionally
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FREQUENCY |
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X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. |
Frequent
Frequent
Frequent |
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3. WORKING CONDITIONS
Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.
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WORKING CONDITION ENVIRONMENTAL FACTOR |
NATURE/REASON OF EXPOSURE |
FREQUENCY |
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Dirt/Dust |
N/A |
N/A |
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Noise |
N/A |
N/A |
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Temperature extremes |
N/A |
N/A |
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Dampness |
N/A |
N/A |
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Vibrations |
N/A |
N/A |
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Equipment movement hazard |
N/A |
N/A |
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Chemicals/solvents |
N/A |
N/A |
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Electrical shock |
N/A |
N/A |
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Significant work pace/pressure |
N/A |
N/A |
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Odors/Fumes |
N/A |
N/A |
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Other (specify):
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Salary : $115,000 - $145,000