Job Description
Level: Management
Job Location: Concord Office - Concord, CA 94520
Position Type: Full TimeEducation
Level: Bachelor's Degree
Salary Range: $108,000.00 - $112,000.00 Salary/year
Travel Percentage: Negligible
Job Shift: Day
Job Category: InsurancePOSITION SUMMARY: Under minimal supervision, manages and directs the activity of a Self-Insured claims unit, ensuring high-quality results and management of claims in compliance with state laws and company/client procedures. This position requires considerable interaction with the client, management, other Claims Examiners, and other TRISTAR staff in the office; therefore, consistently being at work in the office in a timely manner is inherent to this position.
DUTIES AND RESPONSIBILITIES:
- Directly supervise 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 and Client guidelines. *
- Performs file reviews to monitor compliance with policies and laws. *
- Establishes appropriate supervisory diaries on claim files and completes pending diaries on or before scheduled due dates. *
- Prepares for claim audits, reviews audit results, and provides appropriate rebuttal feedback.*
- Coordinates and leads training sessions for staff on updated laws, policies, and procedures.*
- Ensures daily caseload staffing requirements are met.*
- Responds to claimant and vendor concerns and issues as needed.*
- Ensures client servicing instructions are being adhered to.*
- Analyzes monthly client reports.*
- Facilitates internal and external audits.*
- Coordinate and attend client file reviews and staffing meetings in-person or telephonically.*
- Other duties as assigned, including supervision of other jurisdictions as needed*.
*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: Bachelor’s degree in related field (preferred); 5 (five) + years related experience; or equivalent combination of education and experience.
Knowledge, Skills and Abilities:
- Technical knowledge of statutory regulations.
- 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 the ability to convey technical details to claimants, clients, and staff.
- Ability to manage employees of various skill levels.
- Excellent interpersonal skills.
Other
Qualifications:
- Certifications and/or licenses as required by State regulation.
Mental and Physical Requirements: [see separate attachment attached for a copy of checklist of mental and physical requirements]
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- - - MENTAL AND PHYSICAL REQUIREMENTS
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- - - - MENTAL EFFORT
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- - - - Reasoning development:
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- - - - - Solve practical problems; variety of variables with limited standardization; interpret instructions.
- - - - - Logical or scientific thinking to solve problems; several abstract and concrete variables.
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- - - - Mathematical development:
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- - - - - Add, subtract, multiply, and divide whole numbers.
- - - - - Arithmetic calculations involving fractions, decimals, and percentages.
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- - - - Language development:
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- - - - - Ability to compose original correspondence, follows technical manuals, and have increased communication with people in person or on the phone.
- - - - - Ability to evaluate technical data.
- - - - - Ability to interview job applicants.
- - - - - Ability to give direction, provide advice and feedback, and reprimand as necessary.
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- - - - PHYSICAL EFFORT
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- - - - Physical activity required to perform the job:
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- - - Light work:
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- - - - Exerting up to 20 pounds or force occasionally.
- - - - Exerting up to 10 pounds frequently.
- - - - Exerting a negligible amount of force constantly to move light objects.
- - - - Frequent sitting, standing, and walking.
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- - - - Visual requirement necessary to perform the job:
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- - - - Near vision: clarity of vision at 20 inches or less.
- - - - Mid-range vision: Clarity of vision at distances of more than 20 inches and less than 20 feet
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- - - - PHYSICAL EFFORT (cont.)
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- - - FREQUENCY
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- - - - Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):
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- - - Repetitive Motion: Substantial movement (motions) of the wrists, hands, and / or fingers.
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- - - - WORKING CONDITIONS
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- - - Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.
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