Permanent Claims Team Lead
Syracuse, New York
• Supervise the operation of multiple teams of examiners and technical staff for single or multiple product lines which administer workers compensation and/or general liability claims for clients
• Monitor colleagues' workload, provide training, and monitor individual claim activities
• Provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims
• Supervise multiple teams of examiners, single of multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.
• Identify and advise management of trends, problems, and issues as well as recommended course of action; inform management of new procedures and ideas for continuous process improvement; and coordinate with management projects for the office
• Provide technical/jurisdictional direction to examiner reports on claims adjudication
• Compile, review and analyze management reports and take appropriate action
• Perform quality review on claims in compliance with audit requirements, service contract requirements, and quality standards
• Act as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
• Review reserve amounts on high cost claims and claims over the authority of the individual examiner
• Monitor third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
• Maintain contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.
• Assure that direct reports are properly licensed in the jurisdictions serviced.
• Ensure claims files are coded correctly and adequate documentation is made by claims examiners.
• Administer company personnel policies in all areas and follow company staffing standards and training recommendations.
• Interview, hire, and establish colleague performance development plans; conduct colleague performance discussions
• Provide support, guidance, leadership and motivation to promote maximum performance.
• High School Diploma, Bachelor’s Degree preferred
• Six (6) years claims experience or equivalent combination of education and experience required. Two (2) years claims supervisor experience preferred.
• Thorough knowledge of claims management processes and procedures for multiple product lines
• Licenses as required – NEED to have NY Worker’s Compensation (WC) Claims Experience
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Leadership/management/motivational skills
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations
• Credit security clearance, confirmed via a background credit check, is required for this position.
• No telecommuting
• 5 to 6 examiners report to the supervisor
• Examiners will have case load of 140