This position is remote in the state of California only.
ADP is hiring a Claims Lead Examiner.
RESPONSIBILITIES :
- Assist Claims Manager in monitoring the workers compensation program within the ADPTS / PEO structure.
- Review and resolve complaints raised by exterior business partners.
- Identify and track trends with specificity that could be problematic and take steps along with Claims Manager to take steps to develop processes to correct.
- Review and provide concurrence to T.P.A. for reserves, settlements, and other items per Special Service Instructions.
- Consistently consult and collaborate with T.P.A. and internal and external business partners.
- Ability to read data specific dashboards to orchestrate evaluation and analysis of claims to meet department and company goals.
- Monitor and ensure qualitative claim handling through T.P.A. and other vendor partners.
- Resolve escalated complaints and / or concerns by clients, risk and safety, H.R. and other internal business partners.
- Promotes interactive process and early return to work programs.
- Perform regular reviews of claims by specified criteria on diary.
- Provide regular reviews and provide feedback and recommendations for resolution of claim files as needed.
REQUIRED SKILLS :
- Possesses professional communication, both written and verbal to facilitate exceptional customer service and resolution for client complaints and issues.
- Possesses the ability to research complex issues with internal and external parties in a professional, empathetic manner.
- Ability to adhere to a daily schedule and organize yourself to deal with a high volume of inbounds calls and emails requiring responses within a reasonable period of time.
- Excellent interpersonal and communication skills and the ability to work independently, discretely, handling information with confidentially.
- Innovative and successful in implementing best practices for real, measurable results in performance, cost containment and overall efficiency.
- Understanding of basic leave processes / law, FMLA, and other related subjects.
- Proficient in the use of Excel, Outlook, Word and other Office suite programs.
TO SUCCEED IN THIS ROLE : Required Qualifications
- 7-10 years of workers compensation claims experience working in a client service / customer service environment rich with the use of state-of the art predictive modeling, and metrics, data analytic tools and HRIS and claims systems.
- Requires comprehensive knowledge of CA and western region state workers compensation administration, including applicable local, state and federal laws pertaining to WC insurance programs.
- Possesses experience evaluating and recommending approval of claims reserves and settlements, designated expenditures and recovery forfeitures as needed.
- Bachelor's degree or equivalent in experience
BONUS POINTS FOR THESE : Preferred Qualifications
- Comprehensive knowledge of western region states with general insurance policy coverage and state case laws.
- Understands the ins and outs of workers compensation claims within a PEO environment.
- Familiarity and use of Risktrac and Origami.
- Southern CA area ideal.
1 day ago