Job Description

Level: Experienced
Job Location: Philadelphia Office - Philadelphia, PA 19107
Position Type: Full TimeEducation
Level: High School Diploma or GED
Salary Range: $100,000.00 - $115,000.00 Salary/year
Travel Percentage: None
Job Shift: Day
Job Category: Admin - ClericalPOSITIONS SUPERVISED: Directly: Claims Examiners, Claims Assistants; may supervise File/Mail Clerks, Data Entry Clerk, Receptionist, Administrative Clerk and Administrative Assistant. Focus on New York Automobile claims with governmental exposure

POSITION SUMMARY: Under minimal supervision manages and directs activity of claims unit ensuring high-quality results and management of claims in compliance with state laws and company procedures, including Article 51 – New York State No Fault law and New York Insurance Department Regulation No. 68.
This position requires considerable interaction with NYS Office of General Services, 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 guidelines up to reserve authority of $250,000.00 and payment authority of $10,000
- Performs file reviews to monitor compliance with policies and laws.*   This is completed file by file, monthly reviews as required by client and agency file reviews. Coordinates and leads training sessions for staff on updated laws, policies and procedures.*
- Ensures daily caseload staffing requirements are met.*
- Supervises and approves priority payments.
- Responds to claimant and vendor concerns and issues as needed.*
- Monitors effectiveness of vendors and modifies panels as needed.*
- Ensures client servicing instructions are being adhered to.*
- Provides coverage for examiner vacancies due to vacation or vacancies.*
DUTIES AND RESPONSIBILITIES, continued
- Prepares and evaluates weekly and monthly client reports.*
- Facilitates internal and external audits.*
- Conducts and documents in-house and outside educational sessions.
- Attends client file reviews.
- Partners with corporate office and sales/service team for RFP’s and client service issues.
- Other duties as assigned.
*Essential job function.
EQUIPMENT OPERATED/USED: Computer, 10-key, printer, copier, fax machine and other office equipment.
SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.

QualificationsQUALIFICATIONS REQUIRED:
Education/

Experience: High School Diploma or GED required; Bachelor’s degree in related field (preferred); three (3) to five (5) years related experience; or equivalent combination of education and experience.
Knowledge, Skills and Abilities:
- Technical knowledge of statutory regulations and medical terminology.
- 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.
- Knowledge of Arbitration Forum and American Arbitration Association.
Other

Qualifications:
- Certifications and/or licenses as required by State regulation including a valid New York adjuster license.