Posted: Saturday, September 2, 2017 8:09 PM
POSITIONS SUPERVISED: Directly: Claims Examiners, Claims Assistants; may supervise File/Mail Clerks and Administrative Assistants POSITION SUMMARY: Under minimal supervision, manages and directs activity of a CIGA:dedicated claims unit ensuring high:quality results and management of claims in compliance with state laws and company/client procedures. This position requires considerable interaction with the client, management, other Claims Examiners, and other TRISTAR staff in the office; therefore, consistently being at work in the office, in a timely manner, is inherently required of this position.DUTIES AND RESPONSIBILITIES:Directly supervises examiners and clerical staff. Includes monitoring attendance, job performance, evaluations, and disciplinary issues.*Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.*Reviews and approves reserve changes, awards, and payments within Company and Client guidelines.* If company and / or client guidelines set forth approval levels, and that level is above the supervisorA?s, the superior must first approve the request and then escalate it according to company/ client guidelines. Performs file reviews to monitor compliance with policies and laws.*Establishes appropriate supervisory diaries on claim files and completes pending diaries on or before scheduled due dates.*Prepares for claim audits, reviews audit results, and provides appropriate rebuttal feedback.*Coordinates and leads training sessions for staff on updated laws, policies, and procedures.*Ensures daily caseload staffing requirements are met.*Responds to claimant and vendor concerns and issues as needed.*Ensures client servicing instructions are being adhered to.*Analyzes monthly client reports.*Facilitates internal and external audits.*Attends client file:staffing meetings in:person or telephonically.*Other duties as assigned.Responsible for all personnel transactions for subordinates assigned to them. i.e. time cards/PTO requests/performance reviews/administrative actions.* *Essential job function.QUALIFICATIONS REQUIRED:Education/Experience: BachelorA?s degree in related field (preferred); three (3) to five (5) years related experience; or equivalent combination of education and experience.WCCA and/or WCCP preferred. CIGA experience preferred. Knowledge, Skills and Abilities:Technical knowledge of statutory regulations including rules and procedures relating to the California Insurance Guarantee Association (CIGA).Ability to work on a diary system, prioritize tasks and meet strict deadlines.Strong analytical skills.Proficient in Word and Excel.Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.Ability to manage employees of various skill levels.Excellent interpersonal skills. Other Qualifications:Certifications and/or licenses as required by State regulation.
• Location: Sacramento
• Post ID: 18479327 sacramento