Workers Compensation Claims Manager

Division: TSIB - Risk Services

Project Location(s): Saddle Brook, NJ 07663 USA

Minimum Years Experience: 8

Travel Involved: 20-30%

Job Type: Regular

Job Classification: Experienced

Education: Bachelors Degree

Job Family: Insurance and Claims

Compensation: Salaried Exempt

Position Description:

Oversee insurance carriers and Third-Party Administrators (TPAs) in their management and handling of affiliated clients’ Workers’ Compensation claims in an assigned geographic region of the country based upon program and compliance regulations.

Essential Duties & Key Responsibilities:

Physical Demands:

• Oversee assigned workers’ compensation case portfolio of minor to complex claims in assigned geographic region.
• Leverage knowledge of workers’ compensation policy and manage incidents, and dispatch nurse case managers as necessary.
• Collaborate closely with Risk Management leadership on workers’ compensation claims, process, and procedures to ensure integrated program.
• Serve as resource for injured employees and inform of workers’ compensation process and procedures.
• Report workers’ compensation claims to carriers and Third-Party Administrators (TPAs), including notification of questionable claims.
• Facilitate proactive identification of claims with opportunities for early Return to Work and light duty Return to Work program, as needed.
• Evaluate and respond to Reserve and Settlement Consultations within given authority, escalate consultations above scope authority to appropriate leadership.
• Maintain diary for open claims and document specific claim related activities in Risk Management information system.
• Work with carriers, TPAs, and Defense Counsel to develop mitigation strategies for Owner Controlled Insurance Program (OCIP) that result in cost savings to the claim, ensure aggressive strategy is developed on litigated claims, and bring claims to timely resolution.
• Collaborate with General Liability team to develop mitigation strategies and facilitate most economic global resolution of Contractor Controlled Insurance Program (CCIP) claims.
• Attend hearings and mediations on as needed basis.
• Ensure avenues for potential claim recovery are identified and pursued and manage lien recovery on case-by-case basis.
• Participate in claims review process and monitor claims handling process by carriers and TPAs; provide direction to ensure compliance with best practices and special handling instructions.
• Oversee and hold vendors and defense firms accountable for adherence to standard protocols, agreed to service instructions, and litigation management guidelines. Update instructions and guidelines and provide recommendations to appropriate leadership.
• Partner with Safety team and onsite medics on initiatives that support worker wellness and post-injury care.
• Participate in CCIP kickoff meetings and jobsite walkthroughs, attend Claims, Safety and Operations meetings to monitor current and anticipated project risks and report on claims status for specific projects.
• Maintain and foster relationships with carriers and TPAs claims teams.
• Assist with claim data analysis and claim performance reports.
• Collaborate with HR and Payroll departments for completion of required Workers’ Compensation Jurisdictional Forms.
• Support audits related to workers’ compensation claims.
• Remain current on Workers’ Compensation laws and regulations, industry trends, and case law within assigned jurisdictions.
• Other activities, duties, and responsibilities as assigned.
• Qualifications:
• Bachelor Degree in Insurance, Risk Management, Finance, Business Administration or related program; with minimum of 8 years of workers’ compensation claims administration experience; or equivalent combination of education, training, and/or experience
• Experience with workers’ compensation claims in a construction environment, desired
• CRIS, ARM or similar insurance designation, desired
• Knowledge of jurisdictional laws and regulations for assigned territory
• OSHA (Occupational Safety and Health Act) knowledge and experience desired; OSHA 30-hour certification, a plus
• In-depth knowledge of workers’ compensation claims, medical management procedures, medical cost containment programs and applicable laws and regulations
• Demonstrate process thinking and sound decision-making skills
• Analytical and adept at processing and breaking down data into actionable information
• Self-starter with strong project management skills and capable of managing concurrent complex projects and tasks successfully to completion
• Demonstrate strong interpersonal and teamwork skills with ability to work with individuals across organizational levels, both internal and external
• Professional written and verbal communication, and effective presentation skills
• Proficient computer skills, Microsoft Office suite of applications, and insurance-based risk management information systems
• Limited travel
  
  
  

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to sit, use hands to finger, handle, or feel objects, tools, or controls; and reach with hands, talk, and hear. The employee frequently views a computer monitor and frequently uses a computer keyboard. Specific vision abilities required by this job include close vision, peripheral vision, depth perception, and the ability to adjust focus. The employee is occasionally required to be mobile, and the employee occasionally travels both short and long distances via a variety of conveyances. The employee occasionally performs work on-site at construction work sites, office locations, and/or off-site venues. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee regularly works in an office setting. The noise in the work environment is usually quiet to moderate in an office setting. While performing the duties of this job, the employee may occasionally work at construction work sites where the employee is exposed to moving mechanical parts, high precarious places, fumes or airborne particles, outside weather conditions, and risk of electrical shock. The noise in the work environment is usually moderate to loud. The employee is required to work in compliance with company safety policies, procedures, and applicable laws.

The salary range for this position in the New York Metropolitan Area is $112,000 – $173,000

Turner Surety and Insurance Brokerage, Inc. is an Equal Opportunity Employer

Minorities/Females/Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity

VEVRAA Federal Contractor

Turner Surety and Insurance Brokerage, Inc. is an Equal Opportunity Employer —minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity.

VEVRAA Federal Contractor