Worker's Compensation Claims Manager

MRA-The Management Association
long term disability, tuition reimbursement

Jan 02, 2025
Company: Cities & Villages Mutual Insurance Location: Wauwatosa, WI Position: Worker's Compensation Claims Manager Under the direction of the Chief Operating Officer (COO) this position is responsible for supervising the worker's compensation claims division; managing, assigning, oversight, and review of the worker's compensation claim files; investigating, processing and adjusting worker's compensation claims for member municipalities. Some travel may be required with occasional overnight stays. WHY JOIN THE CVMIC TEAM: The ability to make a difference to internal and external customers! Great variety in what you do each day Flexibility with your schedule A supportive team environment Outstanding benefits that include: Company-paid retirement contribution into a SEP Plan (12.1% of salary, after one year of employment), Company-paid health insurance monthly premiums, and tuition reimbursement for continuing education View what employees say about working here! Essential Duties & Responsibilities Manages and oversees the worker's compensation claims process from initial report to resolution. Monitors the state website to ensure state requirements for reporting and payments are being met. Identifies claims with re-insurance/excess insurance exposure and reports these claims to the Chief Executive Officer (CEO), COO, Carrier, and Broker. Reviews and analyzes claims to determine compensability and appropriate benefits. Maintains accurate and up-to-date records of all claims, diaries, and related documentation. Coordinates with injured employees, medical providers, legal representatives, and insurance carriers. Develops and implements strategies to reduce claim costs and improve claim outcomes. Develops, modifies, and administers policies and standard operating procedures (SOP's) related to worker's compensation programs, activities, and claims; Advises and consults with management, employees, and others regarding worker's compensation policies and SOP's including incident reporting and obtaining appropriate treatment. Develops and recommends policies and claim procedures relative to the self-insured worker's compensation programs; administers the day-to-day operations of the assigned programs. Ensures compliance with all relevant Wisconsin worker's compensation laws and regulations. Prepares and presents reports on claims activity, trends, and performance metrics. Collaborates with other departments to promote workplace safety, injury prevention, and a smooth claims-handling process. Leads and maintains excellent Member relations, including resolving customer service issues, attending member meetings, and supporting employees when engaging with Members. Responds to difficult and sensitive inquiries and complaints and assists with resolutions and alternative recommendations. Promotes continuous process improvement by evaluating current services, staying informed on new service offerings, and providing organizational input as appropriate. This includes developing or modifying policies and procedures and looking for ways to improve processes or systems. Monitors changes in laws, regulations, and technology that may affect CVMIC or departmental operations; Implements policy and procedural changes as required. Prepares and analyzes a variety of internal and external reports, to evaluate program trends and outcomes, vendor performance, and Member compliance with programs. Prepares the annual department budget, and ensures that the program operates within the budget. Conducts regular file reviews for Claims Specialists. Conducts file reviews with CVMIC representatives and members as needed. Other Duties & Responsibilities Oversees the Section 111 Mandatory Medicare Reporting. Attends Administrative hearings as needed. Provides Worker's Compensation training for members as needed. Provides training and support to employees on worker's compensation procedures and best practices. Conducts regular department meetings and participates in all manager meetings. Qualifications Associate's degree (A. A.) or equivalent from two-year college or technical school; Five to seven (5 - 7) years related experience and/or training; or equivalent combination of education and experience. A Bachelor's degree and three - five (3 - 5) years of supervisory experience is preferred, but not required. Knowledge, Skills & Abilities To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Knowledge of: The methods and techniques of worker's compensation file review and audit. The principles and best practices of worker's compensation claim handling. Wisconsin Worker's Compensation Act, Administrative Code, and case law. Duty disability and long term disability benefits, including 40.63 and 40.65. The principles and practices of employee supervision, including work planning, assignment review and evaluation, discipline, and the training of employees in work processes. The principles and practices of leadership. Sources of information related to a broad range of programs, services, and functions related to worker's compensation. The methods and techniques of risk mitigation. The methods and techniques of research, statistical analysis, report preparation, and presentation. The techniques for collecting, interpreting, analyzing, and reporting complex and technical data and information. The principles and practices of contract negotiation, preparation, and evaluation. The principles and techniques for working with groups and fostering effective team interaction to ensure teamwork is conducted smoothly. Techniques for providing a high level of customer service by effectively dealing with Members, vendors, partners, and employees. Claims software, Outlook, Excel, and Microsoft Word or similar business software. ADA, FMLA, and Medicare set aside laws. Ability to: Provide training and development opportunities, ensure work is performed effectively, and evaluate performance in an objective and positive manner. Assist in developing and implementing goals, objectives, practices, policies, procedures, and work standards. Manage multiple priorities and work effectively under pressure. Conduct complex research projects on a wide variety of worker's compensation and risk management topics, evaluate alternatives, make sound recommendations, and prepare effective technical reports. Prepare clear and concise reports, correspondence, policies, procedures, and other written materials. Coordinate project planning, research, and analysis. Recommend and implement goals, objectives, and practices for providing effective and efficient services. Plan and manage complex projects and interdepartmental project teams. Evaluate and develop improvements in operations, procedures, policies, or methods. Maintain confidentiality and be discreet in handling and processing confidential information and data; Handle sensitive situations in a professional manner that reflects favorably upon the member and Company. Understand, interpret, apply, explain, and ensure compliance with applicable Federal, State, and local laws, rules, regulations, policies, and procedures. Maintain a variety of filing, record-keeping, and tracking systems. Accurately calculate and verify indemnity payments as required by the Worker's Compensation Act and Wisconsin Administrative Code. Communicate professionally, timely, and effectively, both orally and in writing. Work effectively as part of a management team. Interact effectively with others inside and outside the organization. Effectively and professionally represent CVMIC and present information and respond to questions from clients, claimants, medical service providers, attorneys, and representatives from governmental agencies. Use tact, initiative, prudence, and independent judgment within general policy, procedural, and legal guidelines. Establish, maintain, and foster positive and effective working relationships with those contacted in the course of business. Work with limited supervision. Work proficiently in claims management software and Microsoft Office Suite.