Job Description

Summary: Under limited supervision and with significant independent judgment, supervises and directs the handling of workers' compensation and MI PIP claims by performing the following duties:

Essential Duties and Responsibilities

1. Provides claims oversight and management expertise, including:

a. Oversee the management and resolution of all Workers’ Compensation claims (including non-litigated and litigated claims), and non-litigated PIP claims.

b. Establishes claim-handling strategies and provides direction on complex, high-exposure, catastrophic, disputed, and litigated Workers’ Compensation claims.

c. Ensures appropriate investigation, evaluation, reserving, medical management, negotiation, litigation strategy, and timely claim resolution.

d. Recommends defense counsel. Monitors and evaluates defense counsel’s performance, rates, and geographic areas covered.

e. Oversee Medical Bill Review for Workers’ Compensation and PIP, including quality, cost containment, vendor performance, and compliance.

f. Maintains effective workflows and promotes consistent delivery of a high-quality work product.

g. Monitors claim outcomes, reserve adequacy, litigation results, medical costs, quality, productivity, and customer service.

h. Ensures compliance with applicable laws and regulations, fair claims handling practices, internal standards, and authority guidelines.

i. Identifies trends and implements improvements to claim outcomes, processes, service, and operational performance.

j. Participates in budgeting, staffing, workload planning, and resource allocation.

k. Builds effective relationships with defense counsel, vendors, agents, policyholders, and internal business partners.

1. Functions as the manager of employees within a major organizational business unit, generally through subordinate leaders, including:

a. Communicates vision, priorities, performance expectations, and organizational goals.

b. Develops and recommends strategic and operational plans and organizes resources to achieve business results.

c. Trains, coaches, develop, and leads staff.

d. Oversee performance management, including performance planning, appraisal, employee development, and corrective action.

e. May recommend and/or implement employment actions, including employment/termination, corrective action, promotions/demotions, salary changes, etc.

1. Performs other duties as assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience:

Level 6: Six to ten years in a related role, or equivalent combination of education and experience.

Certificates, Designations, Degrees, and Licenses:

CPCU Preferred

A minimum requirement for this position is the ability to work legally in the United States. No visa sponsorship/support is available for this position, including for any type of U.S. permanent residency (green card) process.