The Workers’ Compensation Supervisor supervises claims adjusters as well as handles their own case load of workers’ compensation claims. This individual confirms compensability of claims and monitors closely for possible lost time. The Workers’ Compensation Supervisor corresponds with insured’s, claimants, and providers when applicable.
- Examines claim files to determine if proper investigation, evaluation, negotiation, settlement and communication techniques and procedures are being followed.
- Advises staff on questions of coverage, compensability, liability, claim value and strategy.
- Ensures that timely, adequate reserves have been established.
- Educates and trains employees.
- Assigns claims based on staffing levels, claim volume, type of claim and adjuster experience.
- Conducts quarterly audits on closed claim files.
- Monitors and controls claim costs and adjustment expense.
- Manages all types of complex claims, including but not limited to lost time.
- Independently analyzes case facts to establish timely and accurate reserves. Requires knowledge of medical disabilities and related costs, as well as likely duration of claim.
- Conducts prompt and thorough investigation of case facts. Interprets and applies appropriate statutes, regulations and case law to determine compensability.
- Recognizes potential for subrogation and places appropriate parties on notice.
- Makes timely and accurate payment of benefits and ensure accurate and timely processing of required EDI-R3 filings with the State.
- Manages and documents medical treatment and takes necessary actions to bring claim to closure including obtaining authority to set appropriate reserves and settlement amounts.
- Notifies Reinsurers when claims and or reserves reach certain levels per company standards and provides updates as necessary.
- Follows-up with medical providers and employer regarding injured workers’ progress. Ensures quality case and medical management by applying appropriate medical concepts, and by interpreting and applying appropriate statutes and regulations.
- Uses independent judgment to apply facts of case and render accurate decisions.
- Schedules medical or testing appointments and provides authorizations.
- Demonstrates sound medical management skills and aggressive claims handling, proactively pursuing return to work.
- Reviews case facts to identify possible fraud throughout the course of the claim.
- Reviews and approves or denies medical bills.
- Completes regular claim reviews with a clear plan of action addressing ongoing claim management, reserve adequacy and rationale to facilitate quick resolutions and the best possible outcome.
- Attends mediations and obtains settlement authority from clients.
- Manages litigation by providing detailed investigative material to respective defense attorneys.
- Makes recommendations to defense attorney on litigation strategy in order to develop the best strategy and outcome.
- Ensures that petition for benefits are responded on a timely basis. Follows adjuster diaries for timely completion of routine claim functions e.g. indemnity payments, all required state filings, claim status report due dates, claim reviews.
- Mentors less experienced claim adjusters.
- Maintains professional and technical knowledge by attending appropriate CEUs and classes.
- Performs other duties as assigned.
- Excellent communication and interpersonal skills; expresses thoughts and ideas clearly, both verbally and in writing; establishes trust and confidence quickly.
- Able to comprehend simple written and oral instructions.
- Basic skills in Microsoft Office (primarily Word and Excel). Must be computer literate with the ability to learn new software applications.
- Ability to effectively supervise and motivate a team.
- Ability to function effectively under tight time constraints, consistently meet strict deadlines, prioritize, and handle multiple tasks in a demanding work environment.
- Ability to communicate appropriately and build professional relationships with employees.
- Willingness to adhere to all principles of confidentiality.
- Ability to represent the company in a professional manner to customers and clients.
- Ability to maintain a high level of tact and professionalism.
EDUCATION AND QUALIFICATIONS
- High School Diploma, college degree preferred or one to two years related experience or equivalent combination of education and experience.
- One to three years of supervisory experience, preferably in a workers’ compensation claims.
- Workers’ Compensation Adjuster License or All-lines Adjuster License.