Job Summary:

Under the direction of the Sr. Director of Leave Management, the Manager - Leave Management (Workers' Compensation) will be responsible for managing the day-to-day performance for the network's workers' compensation programs and the oversight and activities of a team of Specialists. Additionally, the Manager will be responsible for the performance, development and coaching of the Specialists. Furthermore, this role is responsible for managing and minimizing the potential legal and financial risk to the organization through active involvement in the workers' compensation programs.

Responsibilities:

• Managing the Claims Process - Through the department managers and in coordination with other departments, the Manager, Workers' Compensation will be responsible for planning, directing and maintaining the department's claims process from the inception of a claim to its resolution and closure.
• Applies knowledge of insurance laws and best practices in workers' compensation, safety/loss control, claims advocacy, training, and research/data collection methods, etc. to establish policies and procedures for work situations that are varied and complex.
• Manages a team of Leave Specialists (Workers' Compensation) in the day-to-day handling of claims.
• Meets regularly as needed with staff to review the status of cases/claims.
• Working with the claims team, provides continual feedback as to the effectiveness of strategies; performs compliance oversight and drives closures.
• Ensures TPA manages claims diligently, works with Management and legal resources to manage relevant claim details, implements plan for timely resolution of claims and reviews claims with TPA for causation and possible subrogation opportunities.
• Partners with leadership in strategizing new opportunities to minimize exposure acceptable to policy standards; as well as the management, negotiation and participation in the renewal of all insurance programs, working with brokers, and actuaries to administer insurance policies.
• Works with the Sr. Director to implement corrective action plans.
• Direct day-to-day oversight which include tracking measures/metrics, producing and analyzing reports, and reinforcing goals for all workers' compensation claims.
• Interfaces with various internal departments (Risk Management, Human Resources, Finance, Legal) as well as insurance brokers, carriers and third-party administrators on potential, open and closed claims.
• Reviews all open claims every 30 days internally to explore opportunities for cost containment and potential recoveries. Partner with all relevant parties such as carrier adjusters and defense counsel on a plan of action.
• Participates in quarterly claims reviews with Leadership, TPA, and attorneys.
• Serves as point of contact for all departmental escalations including internal as well as external.
• Conducts annual performance reviews with individual staff members, develop and implement performance plans or deficiency improvement plans.
• Perform other duties as assigned or required.

Experience:

10 years' of experience in Workers' Compensation in a high volume, fast paced environment and 5 years of experience in a supervisory/management role.

Education:

Associate's degree, required. Bachelor's degree of education and experience required.

Licenses / Certifications:

Other:

Special Requirements:

• Demonstrated successful ability to lead people and get results through others.
• Knowledge of federal, state, and local laws regulating risk and workers' compensation management (e.g. Department of Labor & Workers' Compensation Board, etc.).
• Knowledge of claims investigation and solid analytical skills necessary to make decisions and resolve issues inherent in handling claims while maintaining confidentiality.
• Ability to work in fast paced environment and cooperatively with co-workers and managers.
• Exceptional organizational skills to include attention to detail, time management, focus on priorities, thoroughness, follow up and multitasking.
• Proficiency in MS Office products (Word/Excel), internet, and website navigation.
• Ability to handle ad hoc requests including generating Excel reports, analyzing data and creating content.
• Outstanding verbal and written communication skills required with the ability to successfully interact at all levels of the organization while functioning as a team player.

About Us:

NorthEast Provider Solutions Inc.