BASIC FUNCTIONThe Transition Unit Supervisor is responsible for the acclimation, training, performance, effective operation, and supervision of a training unit of Claims Professionals handling a variety of claims. This role focuses on assuring the efficient application of initial medical claims training as well as managing the transition of team members to indemnity training and claims handling. This position is responsible for the management of a team managing medical-only and non-complex indemnity claims across multiple jurisdictions.
ESSENTIAL RESPONSIBILITIES- Ensure team member completion of all medical claims training topics, and effective application of training on the job; support training topics with various resources including one-on-one coaching and practical application exercises in Compass, CXP and Salesforce
- Ensure successful transition to and completion of appropriate indemnity training topics, and transition to an indemnity team; identify and recommend appropriate timing of and indemnity team placement
- Manage the workflow of the unit including planning, assigning, and directing work; ensure continuing education requirements of the team are met and maintained timely
- Ensure the team manages claims in compliance with Company policies, applicable statutes, regulations, regulations and case law across various jurisdictions; monitor claim management and provide direction and intervention as appropriate
- Ensure claim reserves and benefit payments are accurate and timely
- Manage the team's efforts to produce successful claim outcomes for providing compassionate care to our recovering workers while achieving high service levels, timely medical management decisioning, prompt claim closures, effective claim cost containment, achievement of goals, and satisfactory claim audits
- Successfully implement changes to the laws and regulations governing claims handling and communicate their impact to the processes, tactics, and strategies of claim management
- Address policy exceptions, inquiries, escalated issues, and complaints appropriately
- Introduce and orient team to internal network of Medical Management, Legal and Subrogation teams, as well as external legal and investigation vendors; facilitate relationship-building
- Ensure unit achieves organizational goals via prompt claim closures, high client satisfaction with service, and effective, strategic cost containment
- Foster and guide the personal and professional development and growth of individual team members to help them build successful and satisfying careers while producing excellent results
- Identify and communicate training needs, assist with facilitating training topics, and support the concepts and techniques taught throughout the training program
- Actively reinforce and support Company programs and initiatives regarding strategic and tactical innovation and improvement
- Maintain workplace culture of professionalism, collaboration and inclusion, and excellence in service, aligning with our Mission and Shared Values; serve as a role model by embodying the highest standards of performance, behavior, and ethical standards
QUALIFICATIONS- EDUCATION: High school diploma or equivalent educational certification required; Bachelor's degree from an accredited college or university preferred
- EXPERIENCE: Minimum of two years of relevant experience and training, or an equivalent combination of education and experience; prior supervisory experience in workers compensation claims management preferred.
- REQUIRED CREDENTIALS: Credentialed/licensed to adjust workers compensation claims in one or more jurisdictions, one of which is California.
- LANGUAGE ABILITY: Able to read and interpret complex documents including statutes, regulations, legal opinions, legal letters, medical records, medical bills, medical resource materials, investigation reports, claim notes, and claim data fields. Able to read, analyze, and interpret business periodicals, professional journals, technical procedures, medical reports, bills, legal briefs, statutes, regulations, and court opinions. Able to write clear, concise reports accurately conveying complex and nuanced information. Ability to write clear, effective correspondence on complex medical and legal points to people from all walks of life. Able to effectively present information and respond to questions with executives, clients, attorneys, and customers, both in individual conversations and presentations to groups. Able to investigate, persuade, and negotiate over the telephone
- MATH ABILITY: Able to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Able to compute rate, ratio, and percent. Familiar with the time value of money and reducing future streams of payments to a present value. Familiar with the concept of statistical likelihood as the basis for calculating the value of a possible financial outcome.
- REASONING ABILITY: Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Able to deal with problems involving several concrete variables in standardized situations.
- TECHNICAL ABILITY: Sound knowledge of workers compensation regulations; demonstratable ability to apply them skillfully and consistently.
- COMPUTER SKILLS: Mastery of Microsoft Office applications and working knowledge of SalesForce. Ability to rapidly master the use of proprietary software applications.
In accordance with the California Equal Pay Act, the pay scale for this job is $80,160 - $114,280. This pay scale is an estimate of the salary range the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The actual salary may be above or below the range. The pay scale applies only to this position and only if it is filled in California. The pay scale may be different for other positions or in other locations.
