Workers' Compensation Claims Lead Examiner (Remote in CA)

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.
4 days ago