Claims Manager

Job Title: Corporate Claims Manager

Department: Human Resources, Risk, and Legal

Location: Support Center / Remote Work

Reports To: Vice President, Human Resources, Risk, and Legal

Job Overview:

The Corporate Claims Manager will oversee the company’s internal claims management function, which includes workers' compensation, general liability, auto, and property losses. The role focuses on transitioning from direct claims handling to strategic claims management, ensuring efficient claims processing by our third-party administrator (TPA) in accordance with our policies and procedures. The primary focus of this role is to uphold rigorous criteria for claims management, promote adherence to insurance policies, minimize risk exposure, and drive the continuous improvement of claims handling processes.

Key Responsibilities:

· Develop and implement strategies for proactive claims management by the Third Party Administrator (TPA) in coordination with the WKS Risk Management Department.

· Oversee the relationship with our TPA to ensure adherence to special client instructions while optimizing claims handling efficiency.

· Monitor the TPA's compliance with all contractual obligations, including reporting requirements, financial thresholds, and customer service standards.

· Coordinate with relevant departments (specifically with Operations) and external partners to facilitate effective communication and documentation exchange with the TPA and defense counsel.

· Lead initiatives to address cost controls, claims handling efficiency, litigation effectiveness, and resource management (med-legal, medical control management, etc.).

· Analyze claims data to identify trends, report on key metrics, and drive continuous improvement in claims management.

· Formulate and execute a comprehensive claims strategy that aligns with corporate objectives and risk tolerance levels.

· Liaise with senior management to integrate the claims management strategy with the broader organizational risk management framework.

· Conduct regular performance evaluations of TPAs and implement changes to improve claims handling and cost management.

· Provide training, guidance, and support to the TPA claims team, ensuring a clear understanding of company-specific requirements and expectations.

· Oversee complex claims negotiations and settlements, providing expertise and ensuring outcomes are favorable and compliant with company policies.

· Work closely with the TPA to develop and refine negotiation tactics and settlement strategies to minimize costs and mitigate risks.

· Analyze claims data to identify trends and areas of risk that could impact financial performance.

· Utilize claims data to inform the underwriting process and contribute to the development of risk mitigation strategies.

· Implement and oversee a quality assurance program to ensure claims are handled consistently and to the highest standards.

· Identify opportunities for process improvements and work with the TPA to implement changes that increase efficiency and accuracy in claims handling. Collaborate with TPA to implement process improvements and quality assurance measures.

· Ensure clear and effective communication between all stakeholders involved in the claims process, including legal, finance, and operations departments.

· Prepare and deliver comprehensive claims reports to senior management, highlighting key metrics, trends, and strategic recommendations.

Working Conditions:

· Office environment at the Support Center with regular business hours and remote work from home (with approval); occasional travel may be required.

Physical Requirements:

· Primarily a sedentary role with extended periods of computer use; occasional lifting of office supplies may be necessary.

Physical Activity:

· Sitting for extended periods.

· Repetitive motion for computer use.

· Walking, standing, and reaching occasionally.

Physical Requirements & Work Environment:

· Office setting with standard lighting, temperature, and noise levels.

Education Requirements:

· Bachelor's degree in Business Administration, Risk Management, or a related field.

· Professional certification in claims or risk management preferred.

· Minimum of 5 years of experience in claims management with a demonstrated capacity for claims oversight and strategic thinking.

· Proficient in the use of claims management software and Microsoft Office Suite.

Data Analysis and Reporting:

· Ability to compile, analyze, and interpret claims data to inform strategic decision-making.

· Proficient in creating detailed reports and presenting findings to senior management.

Compliance and Risk Management:

· Ensure all claims activities comply with federal, state, and local regulations.

· Stay updated on changes in legislation affecting claims management, minimum wage, and other relevant areas.

Communication and Documentation:

· Facilitate efficient communication channels between the TPA and internal stakeholders.

· Ensure accurate and timely documentation and record-keeping for all claims activities.

Risk Assessment and Investigation:

· Collaborate with the TPA to oversee the investigation of claims.

· Assess risks associated with claims and recommend appropriate courses of action.

Insurance Policy Adherence:

· Monitor adherence to insurance policies and procedures.

· Work with the TPA to ensure all claims are processed within policy guidelines.

Claims Oversight:

· Provide strategic oversight of the claims process, focusing on efficiency and effectiveness.

· Manage the relationship with the TPA, ensuring they deliver services that meet our organizational standards.

At-Will Employment Statement:

"Employment with WKS and its affiliates is at-will. This means that both the employee and WKS or an affiliate have the right to terminate the employment relationship at any time, with or without cause, and with or without notice. This at-will employment relationship exists regardless of any other written statements or policies contained in the employee handbook, employment longevity, promotions, or changes in position, salary, or any other terms and conditions of employment. The company reserves the right to change any and all terms and conditions of employment, including but not limited to, policies, job descriptions, and benefits, with or without notice. The at-will employment status of an employee cannot be altered except in a written agreement signed by both the employee and the Vice President, Human Resources, Risk Management, and Legal."