Workers Compensation Claims Supervisor
About The Position
Under minimal supervision, oversees the daily operations of a workers’ compensation claims unit to ensure timely, accurate, high-quality claims handling in compliance with applicable state laws, client requirements, and company policies and procedures. Provides technical guidance, training, and performance oversight to assigned staff and collaborates with clients, management, Claims Examiners, and other TRISTAR personnel to resolve claims and service issues. The role directly supervises examiners and clerical staff, manages staffing and caseload distribution, reviews claims and files, makes claims-handling decisions, and approves reserve changes and payments within company and client guidelines. It also supports audits, client reporting and reviews, staff training, vendor evaluation, and claims coverage when examiners are absent or positions are vacant. The position is full-time, day shift, located in Milwaukee–Waukesha, Wisconsin, with no travel. The stated salary range is $95,000–$105,000 per year.
Requirements
- High school diploma or GED.
- Five or more years of related experience, or an equivalent combination of education and experience.
- Strong technical knowledge of multi-state workers’ compensation laws, regulations, and medical terminology.
- Ability to maintain a claims diary system, prioritize work, and meet strict deadlines.
- Strong analytical and problem-solving skills.
- Proficiency in Microsoft Word and Excel.
- Excellent written and verbal communication skills, including explaining technical claims information clearly to claimants, clients, and staff.
- Ability to supervise, coach, and develop employees with varying experience and technical ability.
- Strong interpersonal skills and ability to maintain effective working relationships.
- Ability to manage competing priorities and remain effective under pressure.
- Ability to model a positive, professional attitude for direct reports.
- Ability to respond promptly to client requests and service needs.
- Certifications and/or licenses as required by state regulation.
Nice To Haves
- Bachelor’s degree in a related field.
Responsibilities
- Directly supervise examiners and clerical staff, including monitoring attendance and performance, conducting evaluations, and addressing disciplinary issues.
- Participate in new-hire processes as needed, including interviewing, training, and completing Personnel Action Forms.
- Monitor daily staffing needs, ensure caseload coverage, and distribute caseloads equitably among direct reports.
- Review and address scheduled claims issues, including initial and periodic reviews, delays, and denials.
- Perform file reviews to monitor accuracy and compliance with policies and laws, and ensure consistent and accurate claim coding.
- Prepare agendas for and lead team meetings with direct reports.
- Make daily claims decisions concerning claim strategies, action plans, payments and recoveries, and carrier or excess reporting.
- Run supervisory reports to monitor performance and assist direct reports.
- Review and approve reserve changes and payments within company and client guidelines.
- Establish supervisory diaries on claim files and complete pending diaries by their due dates.
- Prepare for claim audits, review audit results, and provide appropriate rebuttal feedback.
- Coordinate and lead internal and external training sessions on updated laws, policies, and procedures.
- Respond to claimant and vendor concerns and facilitate timely resolution.
- Evaluate vendor effectiveness and modify vendor panels as needed within TRISTAR and account guidelines.
- Ensure staff follow client service instructions and applicable state reporting requirements.
- Provide claims-handling coverage during examiner absences and position vacancies.
- Prepare, evaluate, and analyze monthly client reports.
- Coordinate, facilitate, and support internal and external audits.
- Participate in client file and claim reviews and address action items.
- Partner with the corporate office and sales and service teams on requests for proposals and client service issues.
- Adhere to TRISTAR’s Best Practices and perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
High school or GED
