Claims Manager - Workers Compensation

Stanford Health Care • Sacramento, CA

28d • $67 - $88 • Remote

About The Position

Under the direction of the Director, Claims & Litigation Strategy, the Claims Manager oversees the workers' compensation claims program for Stanford Health Care, Stanford Health Care Tri-Valley, and Stanford Children's Health. The Claims Manager acts as the primary liaison with the third-party administrator (TPA) to ensure proper claims handling and with internal partners to evaluate and reduce work-related injuries.

Requirements

• Bachelor’s degree in a work-related field/discipline from an accredited college or university.
• Minimum five (5) years of progressively responsible and directly-related work experience.
• Ability to analyze and develop solutions to complex problems.
• Ability to apply judgment and informed decisions.
• Ability to communicate effectively in written and verbal formats including summarizing data and presenting results.
• Ability to establish and maintain effective working relationships.
• Ability to work effectively both as a team player and leader.
• Knowledge of computer systems and software used in functional area.
• Knowledge of local, state and federal regulatory requirement related to the functional area.
• Knowledge of medical terms, concepts and practice.

Nice To Haves

• Claims Practitioner in Workers’ Compensation (CPWC) certification preferred.

Responsibilities

• Responsible for oversight of all TPA activities to ensure efficient and cost-effective claims handling in accordance with hospital policies and procedures and the applicable service agreement.
• Review reserves, settlement activity, and claims costs. Participate in periodic claim reviews and provide substantive input regarding claim strategy.
• Participate in negotiation of TPA contracts.
• Serve as liaison with external departments, including Human Resources, Workforce Health and Wellness, and Environmental Health & Safety to coordinate issues impacting claim resolution and injury/illness prevention.
• Participate in periodic committee meetings as warranted. Provide training related to claims workflow and processes.
• Responsible for collection and analysis of claims data. Create reports and disseminate claims data to stakeholders. Evaluate trends to support loss prevention.
• Ensure timely and accurate processing of all claim invoices.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees