JOB PURPOSE: Manage internal and external claims functions by formulating, developing, and coordinating all claims related activities of the organization. Establish and maintain standards for “Best Practices” both internally and externally for all aspects of claim program. This position is HYBID.
- Develop and maintain written policies and procedures and Client Service Instructions for external claims adjusters to ensure clearly defined responsibilities and standards for performance.
- Manage external vendors in the areas of claims administration, managed care, and litigation through benchmarking, loss analysis, and general performance measurement reports to ensure adherence to best practices as well as company specific claim program goals, directives, initiatives, policies, and procedures.
- Conduct and oversee claim reviews and audits to ensure effective claims handling by internal and external adjusters.
- Authorize claim reserves and settlements within established authority.
- Manage collection required regulatory and company specific claim related data to ensure compliance with all record keeping, reporting, loss forecasting, and loss analysis requirements.
- Provide actuarial information, and review and reconciliation of claims related data to third party provider
- Oversee aspects of insurance coverage for US geographies, understand policies, limits, and endorsements as it relates to risk and on-going claims management.
- Review loss information (including actuarial analysis) to proactively identify trends and prevent/mitigate future losses. Assist business units with development of key safety policies and initiatives, and claims performance metrics and programs as well as the development of management and reporting tools to drive reductions in future claim frequency and severity trends.
- Respond to OSHA related inquiries in support of field locations, including but not limited to accidents, inspections and complaints.
- Identify safety opportunities within operations and corporate locations and coordinate with internal departments such as training when action may be necessary.
- Manage Monopolistic and Self Insured claims programs to ensure administrative duties and policies, including Ohio Self Insured Payor Certification, all reporting and premium funding requirements as required.
- Manage the Point of Contact relationship with RAC Legal regarding new and on-going claim litigation.
- Manage the Point of Contact relationship with RAC Leave of Absence to identify Coworkers and any related disability pertaining to WC claims.
- Point of Contact for outside counsel regarding discovery and insurance related litigation for claims.
- Other duties as assigned.
- Bachelor’s degree in related field or equivalent years of professional experience.
- At least ten years of progressive experience handling Multi-State Claims.
- Three to five years of supervisory experience.
- Extensive knowledge within all aspects of adjusting Claims.
- Thorough and proven knowledge of standards, practices, procedures, and various laws applicable to adjusting claims.
- Excellent written and verbal communication skills
- Capability to organize and prioritize work.
- Ability to analyze various types of data and produce reports for management.
- Strong computer skills including Excel, Word, Outlook and Access.
- Solid experience working with TPA and insurance comp