Claims Supervisor - Workers' Comp Dedicated Account

Athens Administrators • Fresno, CA

1d • Hybrid

About The Position

Athens Administrators has an immediate need for a Claims Supervisor to support our California Workers Compensation department. Ideal candidates will reside in the Central Valley of California, however, management that lives less than 36 miles from the Concord or Orange, CA office AND have a direct report in the office, are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. Employee work a 37.5-hour work week with the ability to work a flex schedule with every third Monday or Friday off. As a Claims Supervisor, you'll play a pivotal role in leading and collaborating with Athens management to achieve exciting company goals, run insightful reports, and streamline processes. You'll make impactful daily claims decisions, review files for accuracy, and approve payments that exceed examiner authority. Additionally, you'll ensure top-notch file handling, accurate claims coding, and meet unit closing goals. You'll be the guiding force for your team, planning, organizing, delegating workloads, supervising daily activities, providing training, and offering valuable guidance. In client management, you'll address policy and claims issues, build and maintain strong relationships, attend key meetings, ensure compliance with client instructions, and document interactions, always acting in the client's best interest. Join us and make a difference every day!

Requirements

• High School Diploma or equivalent (GED) required for all positions
• Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f) Administrators Certificate from Self-Insurance Plans.
• If not already obtained, the Administrators Certificate from Self-Insurance Plans will be required within one year of employment
• Completion of IEA or equivalent courses
• Solid and in-depth knowledge of workers’ compensation laws, policies, and procedures
• 3+ years’ recent workers compensation claims handling experience at a high level
• At least 2 years Claims Supervisory experience required
• Understanding of medical and legal terminology
• Strong attention to detail and organizational skills and the ability to research and resolve problems and meet multiple deadlines and to plan and effectuate short- and long-range Company and department objectives.
• Proficiency at applying business and technical acumen by understanding how the business works and how technology supports business initiatives. Leverages technology for self and staff to improve efficiency.
• Partnering with team to ensure on time task completion; done through delegation and leading by example, executing tasks rather than just instructing them to execute tasks
• Handles stressful situations and deadline pressures well
• Must demonstrate accuracy and thoroughness in work product
• Effectively influences people to achieve unit and organizational objectives
• Must be flexible, adaptable, and positive. Exhibit passion and energy to ensure that all employees are respected and treated in a manner consistent with Athens Values.
• Able to plan, prioritize and organize claims workload for a unit
• Skilled at presenting in small and large group settings
• Ability to create reports as required, using the report writing tools available or creating custom documents.
• Skilled at developing and maintaining effective relationships with others (co-workers, customers, vendors, management, and other key stakeholders) to achieve organizational goals
• Embrace the leadership role and can be counted on to help senior management drive towards the desired results and to exceed goals successfully.
• Able to interpret information from multiple sources and draw logical conclusions; consults others based on analysis of data; able to think strategically and use data findings to consult others for improved business results.
• Negotiating skills
• Mathematical calculating skills
• Exercise independent judgment and analytic ability in solving complex and sensitive problems
• Highly developed verbal and written communication skills with strong attention to detail
• Computer processing skills, including the ability to leverage technology for self and staff to improve efficiency
• Proficient in Microsoft Office Suite
• Ability to type quickly, accurately and for prolonged periods
• Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
• Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
• Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
• Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner
• Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
• Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
• Valid Driver’s license and availability for travel including in office file reviews and meetings

Nice To Haves

• AA/AS or BA/BS preferred but not required
• 5+ years’ experience in a Workers’ Comp claims lead or supervisor position preferred
• Municipality/4850 experience preferred
• Prior Third-Party Administrator (TPA) experience preferred
• ClaimsXpress program experience preferred but not required

Responsibilities

• Work with Athens management to achieve company initiatives and performance goals
• Consistently strive to improve and streamline current processes
• Authorize release of payment and settlement
• Make daily claims decisions regarding plan of action, handling of payment, etc.
• Review claim files for accuracy
• Run various reports with an eye for accuracy and confidentiality
• Approve payments and reserve increases when they rise above Examiner’s authority level
• Work collaboratively with internal and clients’ senior management as well as with attorneys to draft settlements and assist with litigation strategies
• Provide timely information to clients, attorneys, doctors, investigators and injured workers with strong, professional communication
• Discuss appropriateness of medical treatment with medical case manager
• Assure consistent and accurate claims coding is occurring on the team
• Ensure quality file handling and resolution. This includes meeting unit closing goals, verifying proper reserves, providing thorough claims analysis and guiding to correct resolution
• Use flexibility when working in demanding and changing situations
• Effectively plan, organize and delegate workload for optimal results and to ensure time commitments are met
• Supervise daily activities of the team by monitoring progress, ensuring compliance with policies, and promptly addressing any issues or conflicts
• Identify, coordinate, coach, and perform training with staff to improve performance and increase their growth and knowledge in claims
• Participate in the interview process, onboarding and training of new hires
• Provide general guidance to the team by offering support and advice on work-related issues, fostering a positive work environment, encouraging professional development, and reviewing performance through evaluations, feedback, goal setting, and identifying areas for improvement
• Provide direct feedback and use sound coaching techniques to solve disciplinary or workflow problems.
• Manage and document employee relations issues at all levels.
• Work in conjunction with Human Resources to ensure performance issues are managed in a timely and consistent manner
• Regularly lead organized and collaborative staff unit meetings, including both remote and on-site employees
• Maintain an open-door policy and an approachable attitude, and foster open communication with staff
• Work with clients with issues regarding policies, programs and/or claims
• Manage existing client relationships by being accessible, making regular service calls, and proactively identifying and solving potential problems
• Attend client meetings, internal meetings, and workers’ compensation meetings both virtual and in-person
• Ensure notepads and diaries are set and completed timely in accordance with client handling instructions and Athens Best Practices and have meaningful action plans and information and are concise and well-written
• Obtain audit results meets or exceeds best practice standards of Athens and client
• Display integrity and always acts in the best interest of the client
• Document client meeting notes in appropriate shared location
• Supervising, scheduling, assigning, monitoring, and evaluating work of assigned staff are responsibilities for supervisory positions.
• Provide direct supervision for 6-10 employees, typically consisting of Senior Claims Examiners, Future Medical Claims Examiners, Claims Examiners, Assistant Claims Examiners and Assistant Claims Examiner Trainees.
• Attend on-site Leadership Summit at Athens Concord headquarters every 18 months (including overnight)
• Review and approve direct report’s monthly expense reports
• Ensure that all expenditures are in the best interest of the Company
• Use effective monitoring and reporting mechanisms to control expenses without lowering quality
• Search for and implement hidden cost improvements
• Obtain, maintain, and demonstrate an understanding of wage and hour laws as applicable for employees
• Ensure timely, accurate review and approval of timecards for your staff on payroll processing days.

Benefits

• We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more!
• Further information about our comprehensive benefits package may be found on our website at https://www.athensadmin.com/careers/why-work-here

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED