Career Details

HUMAN RESOURCES

Workers Comp/Claims Manager
posted : 02/06/2023
Status :
Closed
Close Date :
02/20/2023
Salary :
DOQ
Type :
Full Time
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General Job Description

Manages day-to-day claims operations, including claims evaluation, adjudication and customer service in accordance with agreed quality and production standards. Processes claims in a timely manner and complies with industry fair claims practices and applicable state regulations concerning the processing of claims. Prepares budget and sets goals, while being accountable for the results. Manages staff of claims professionals, which may include care coordination and intake nurses, claims examiners, benefit/customer service specialists and administrative support personnel, including the regular and timely evaluation of their performance. Maintains good, professional working relationship with superiors, peers, subordinates and other department managers and personnel.

Duties for this Position
  • Coordinates and facilitates the management of workers compensation claims for Horry County Government (HCG), including assessing, investigating, reviewing, negotiating and determining workers compensation claims, weekly and provisional liability entitlements, approving medical treatment and lump sum payments in accordance with the relevant legislation, regulations, government policies and Performance Standards for Self Insurers.
  • Provides expert advisory, consultancy and training service to HCG business unit managers/supervisors and client agencies in relation to all aspects of workers compensation claims management and administration.
  • Acts as a liaison and provides advice to managers/supervisors, injured employees, medical practitioners, external providers, and union / legal representatives regarding workers compensation matters.
  • Assists in the development, implementation, evaluation, review and improvement of the workers compensation claims management / administration policies, procedures and processes.
  • Knowledge of: *South Carolina's Workers Compensation and Laws, Regulations, Performance Standards for Self Insurers and precedent case law. *Medical and legal terminology associated with the factors influencing the management of work-related injuries/illnesses. *OSHA record keeping for the 300A and 300 Summary Log. *Complex workers compensation claims management including assessing, investigating, reviewing, negotiating and determining workers compensation claims, entitlements and lump sum payments. *Development and implementation of injury management strategies to achieve safe and successful rehabilitation and return to work outcomes. *Demonstrated experience interpreting and consulting on aspects of the legislation, regulations, policies and performance standards relating to workers compensation. *Effective communication and negotiation with a diverse range of clients at various levels (both verbal and written), including medical and legal practitioners. *Successful problem solving, conflict resolution and decision making techniques in the workers compensation environment. *Principles and procedures for developing goals, objectives and management plans.
  • Skills in: *High-level organization and time management. *Computers and applicable softwares. *Interpersonal relations. *Customer service. *Negotiation. *Investigation.
  • Ability to: *Communicate clearly and effectively, both orally and in writing. *Establish preventive programs to reduce risk causation factors. *Analyze and assess programs, policies and operational needs and make appropriate adjustments. *Analyze data and information; draw conclusions; propose responsive actions. *Identify and respond to sensitive community and organizational issues, concerns and needs. *Investigate accidents to determine liability. *Plan, organize, direct and coordinate the work of lower-level staff. *Delegate authority and responsibility. *Select, supervise, train and evaluate staff. *Analyze problems, identify alternative solutions, project consequences of proposed actions and implement recommendations in support of goals. *Research, analyze and evaluate new service delivery methods and techniques. *Prepare clear and concise administrative and financial reports. *Interpret and apply applicable Federal, State and local policies, laws and regulations. *Operate a computer and other office equipment; develop graphic presentations. *Maintain confidentiality. *Establish and maintain effective working relationships. *Contribute to a comprehensive risk management program. *Work with minimal supervision and participate as a team member to achieve agreed outcomes. *Manage high volumes of work and determine priorities to meet strict timelines.
Position Minimum Requirements
  • Bachelor’s degree in business administration, public administration, finance, or related field and five years responsible experience in the operation of risk management programs or related field, including four years of administrative and supervisory experience.
  • Previous workers’ compensation experience (such as adjuster/workers’ compensation paralegal) preferred.
  • Valid South Carolina driver's license.
  • Possession of and the ability to maintain a valid Property and Casualty or Multi-Lines Adjuster License by the South Carolina Department of Insurance is required at the time of hire.
  • Must be able to pass the required pre-employment physical and background check.