Claims Manager

City of El Paso•Various Locations within the City of El Paso, TX

5d•Onsite

About The Position

Under the direction, manages the City of El Paso insurance programs including workers’ compensation, property/casualty, and subrogation/recovery claims. This role involves identifying, assessing, and mitigating risks associated with human, physical, and liability claims. The Claims Manager will administer and coordinate claims processing, implement strategies to prevent, control, and/or transfer risks, and coordinate with internal business partners to establish a framework for mitigating losses. The position also manages all claims to full resolution, administers non-tort claims, and seeks recovery of damages. Responsibilities include administering medical/case management, claims strategy, negotiation, and adjudication. The role involves initiating and monitoring claims investigations, accepting or denying claims, and ensuring the accuracy of claims financial data in the Risk Management Information System (RMIS). Setting financial reserves, conducting reserve audits, and representing the City in legal proceedings are key duties. The Claims Manager also administers the return-to-work program, manages third-party administrator processes, and provides tort notices to the City Attorney’s Office. Claims administration includes establishing processes, policy, and priorities, developing procedures for claims processing and data maintenance, and ensuring program integrity. The role involves conducting claims reviews, advising on budget needs, communicating claims management philosophy, and reviewing regulatory reports. Maintaining current knowledge of relevant statutes and acting as an in-house resource are essential. The position also includes providing education and training to employees and managing recoverable claims for subrogation and insurance recoveries. Assisting with Total-Cost-of-Risk analysis and data analysis is also part of the role. The Claims Manager supervises assigned staff, including assigning work, appraising performance, providing training and development, and managing personnel actions.

Requirements

Bachelor’s Degree or higher in Business or Public Administration, Finance, Risk Management, Insurance, or a related field.
Four (4) years of professional experience administering workers’ compensation, property and casualty insurance claims, self-insurance, or captive insurance programs.
Two (2) years of lead or supervisory experience.
Valid Texas Class "C" Driver's License or equivalent from another state by time of appointment.
Workers’ Compensation Adjustor’s license required within one (1) year of appointment.
Property & Casualty Adjuster License required within one (1) year of appointment.

Nice To Haves

Associate in Risk Management from the Insurance Institute of America
Certified Claims Examiner Certification from the State of Texas

Responsibilities

Identify, assess, and mitigate risks associated with human, physical, and liability claims.
Administer and coordinate claims processing and implement strategies to prevent, control, and/or transfer risks through claims management processes and procedures, self-insurance, commercial insurance, and /or other financial instruments.
Coordinate with internal business partners to establish a framework and methodology to mitigate reported incurred and/or incurred but not yet reported losses.
Manage all claims, with varying degrees of complexity, to full and successful resolution.
Manage and administer non-tort claims and seek recovery of damages.
Administer medical/case management, claims strategy, negotiation, and adjudication of claims within the level of authority.
Initiate and monitor claims investigations, and accept or deny claims.
Monitor and ensure the accuracy of claims financial data maintained in the Risk Management Information System (RMIS).
Set financial reserves for claims and conduct periodic internal reserve audits.
Represent the City of El Paso at settlement conferences, hearings, arbitrations, mediations, and trials.
Negotiate settlements on behalf of the City within the limits of authority.
Administer the return-to-work/transitional duty program for injured workers.
Manage third-party administrator processes on workers’ compensation claims.
Provide all tort notices to the City Attorney’s Office upon receipt.
Establishing processes, policy, and priorities, developing and implementing procedures on claims processing and maintenance of claims data, program integrity, and controls.
Conduct periodic claims reviews and management meetings with departments, third-party claims examiners/adjusters, and City Attorney’s Office.
Advise supervisor on annual claims program budget needs.
Communicate claims management philosophy, case strategy, and financial implications to management.
Review and finalize workers’ compensation regulatory reports and ensure compliance with reporting requirements.
Maintain current knowledge of changes to workers’ compensation, property/casualty, and subrogation/recovery statutes, and act as an in-house resource for departments.
Provide education and training to employees on claims matters, especially workers’ compensation response and policies/procedures.
Manage and coordinate recoverable claims to successfully subrogate and facilitate insurance recoveries.
Assist with Total-Cost-of-Risk analysis, insurance, and self-insured cost forecasting, and data analysis including reviewing and providing input on data trends and variances.
Serve on special project teams and assignments.
Supervise assigned staff, including assigning, scheduling, guiding, and monitoring work.
Appraise employee performance and review subordinate supervisors' appraisals.
Provide for training and development.
Counsel, motivate, and maintain harmony.
Identify and resolve staff differences, conflicts, and deficiencies.
Interview applicants.
Recommend hiring, discipline, termination, promotion, or other employee status changes.
Enforce personnel rules and regulations and work behavior standards firmly and impartially.