Manager, Claims - Workers Comp
Location:
Harrisburg , Pennsylvania
Posted:
October 12, 2016
Reference:
170666894
#claims

JOB SUMMARY: Manages the delivery of workers compensation claims services involving multiple states from a centralized division or multiple field locations. Responsible for accurate and timely review, evaluation, payment, and disposition of claims according to best practices. Promotes and provides "On Your Side" customer service. Insures compliance with statutory and regulatory requirments unique to each State. Manages interaction with other claims areas, business unit leadership and customers/clients. Reviews, coordinates and partners with Office of General Counsel,P&C Claims, and IT in response to Regulatory Advisory notifications to facilitate actions required to insure ongoing compliance or knowledge of regulatory change. Implement and train Associates on new workflows and compliance processes. Is responsible to drive unit performance and key performance objectives to meet and/or exceed expectations, and to promote and insure understanding of key objectives by Associates. Promotes a customer focused environment where Associates deliver a positive On-Your-Side experience to customers or potential customers.

RELATIONSHIP: Reports to DirectorDIRECT REPORTS: 7-8

JOB RESPONSIBILITIES:

+ Manages the delivery of workers compensation claims. Partners with other business units to develop and implement vendor service arrangements designed to assist with cost containment of medical, indemnity and expense; insure timely delivery of services to customers; and insure program compliance with statutory and regulatory requirements for each State serviced. Services are delivered per documented contractual agreements, client service plans and/or insurance contracts (based on business unit/location).

+ Performs and participates In effective quarterly Quality Assurance reviews and annual Supplemental audits. Creates and implements effective Actions Plans associated to areas of opportunity identified. Measure, monitor and insure technical accuracy, customer service expectations, timely reporting to State and other Regulatory agencies. Effectively package claims results to clients, policyholders claims leadership and/or state/regional management. "

+ Responsible for associate management including: performance management, salary planning and administrations, development planning, workforce planning, and day-to-day direct supervisor interactions. Partner with Director/business leader on appropriate Associate authority levels commensurate with experience and demonstrated performance. (Change-Use standard Mgr language and keep authority level info sentence)

+ Monitors and drives appropriate utilization of loss cost reducing vendor relationships to insure customers receive timely and appropriate services at appropriate costs. Develop and partner with Office of General Counsel and Director to appoint new outside counsel in emerging or growth areas.

+ Maintains knowledge of EDI regulatory reporting requirements unique to each State serviced and partners with P&C Claims, IT services, SMS and outside vendors to identity efficient and cost effective means of compliance with data reporting requirements. Monitor data reporting accuracy and submit corrected data/reports to individual State Workers Compensation Bureaus/Departments as required to avoid fines, penalties, and /or sanctions. Develops and impalements departmental workflows that insure timely and appropriate exchange and submission of required data to Workers Compensation Bureaus/Departments.

+ Maintains high-level contact with Regional partners and policyholders to support revenue retention objectives, expense management, and to respond to changing customer needs, as well as competitive initiatives. Promotes "service that sells" behaviors with all Associates.

+ Develops division plans and objectives, and manages operation expenses consistent with annual plan needs, customer/business unit requirements. Monitors and tracks key performance measures and insures compliance with previously identified objectives and targets. Implements and/or recommends plans to achieve divisional plans and objectives.

+ Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers.

+ Oversees and ensures timely and professional responses to all customer and state agency inquiries.

+ Identifies, develops and retains high potential/high performing associates who have the potential for or are ready to fill critical roles in the organization.

+ Creates a working environment that fosters a high level of technical competency, and opportunity for development and growth. Maintains a high level of Associate Engagement by: setting clear priorities and objectives for Associates; keeping them informed; recognizing and rewarding excellence; fostering a diverse and inclusive environment; and listening and responding appropriately to concerns. Embraces change management techniques and fosters a positive response and expectation from Associates.

+ Responsible for the management of associates including performance management, salary planning and administration, training and development, workflow planning, hiring and placement, and disciplinary actions.

+ Other duties as assigned.

JOB REQUIREMENTS:

+ Education: Undergraduate studies in business administration or related field preferred and/or relevant Workers Compensation experience

+ Licenses/Designations: State licensing where required. Successful completion of required/applicable claims certification training/classes.

+ Experience: Eight to ten years work experience in workers compensation claims including at least three years in a supervisory or group leadership role.

+ Knowledge: Extensive knowledge of workers compensation laws, regulatory compliance, and EDI reporting obligations. Proven knowledge of worker compensation claims workflow, processing, administrative policy, practices and procedures. Proven knowledge of insurance contracts, medical terminology and legal aspects of court procedures affecting legal exposures for workers' compensation. Ability to operate various claims systems and related software.

+ Skills/Competencies: Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Command of all skills necessary for verbal and written interaction with all levels of associates, clients/ policyholders, prospective customers, and state agencies. Ability to work cohesively with other business partners to identify problems, make recommendations and implement creative solutions. Proven ability to set work priorities that conform with established standards and to evaluate, determine solutions to work processing problems. Ability to measure work productively effectively and identify efficiencies in work flows and process. Demonstrates leadership qualities, and actions consistent with a positive Associate engagement, and actions consistent with the Nationwide Values. Able to present complex information in a manner easily understandable to other business units or Associates with less experience. Can handle multiple project assignments in addition too and simultaneous to claim management duties. Possesses ability to teach, train and motivate others to perform at a high level of expectation. Expresses and demonstrates customer centric philosophies consistent with Nationwide's customer centric culture. Ability to operate personal computer and related business/claims software.

+ Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.

+ Staffing Exceptions to the above Minimum Job Requirements must be approved by: Business Unit Executive and Human Resources.

JOB CONDITIONS:Working Conditions: Normal office environment. May require ability to sit and use telephone and personal computer for extended periods of time. Must be willing to work irregular hours and to travel with possible overnight requirements. Must be available to work catastrophes (CAT) requiring travel to CAT site with multiple on-site responsibilities and/or for extended periods of time. Extended and/or non-standard hours as required.Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.Job Evaluation Activity: Edited 5/2/11 JTG

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