Self-Insured Claims Manager

POSITION SUMMARY

The Self-Insured Claims Managers’ overall objective is to manage workers’ compensation claims from start to finish. In addition, this position requires direct contact with client to educate, advise, and recommend best practices for claims management.

ESSENTIAL DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:

· Independent discretion and control over day to day claims management.

· Handicap Reimbursement – Identify, filing and attendance at hearings.

· Lump Sum Settlements – Identify, negotiation, customer contact and filing.

· Review of new injuries: certification/rejection, return to work information.

· RTW practices – Knowledge of and recommendations to the employer.

· Client Contact – In person and by phone for current customers. Also to work with Client Relations Managers for prospective customers as needed.

· Employer Education - Knowledge of and recommendations to employer regarding cost containment strategies.

· IME/IMR determination, report review and submission.

· Review of all BWC/IC letters, notices and orders and respond to all requests as necessary.

· Make appropriate recommendations to clientele regarding appeals and responses.

· Complete analysis of new client’s losses and attend initial “meet and greet” as determined by assigned CRM to discuss claim strategies/plan of action.

· Review and preparation of hearing files.

· Attendance for ongoing updates/training internally/externally as deemed necessary by VP of Risk Management.

· Calculation/entering of compensation payments.

· Training and oversight of new and/or current employees as necessary.

· Coordination of MSA’s for all potential settlements.

· Identification, notification and collection of subrogation liens.

· Identification, notification and reimbursement requests to excess carriers.

· Handling of all phone calls regarding inquiries of bill payments/status.

· Bill determination.

· Setting and maintaining reserves based on probable outcome with detailed rationale.

· Other responsibilities as assigned.