Worker's Compensation Team Leader

New York City, New York
Not Specified
Feb 16, 2017
Feb 20, 2017
Job Type
Not Specified
Career Level
Not Specified
Under the guidance of and subject to the approval of the Manager of Workers Compensation, is responsible for all technical and workers compensation specific claims activities required for the company. Responsibilities include statutory claims administration functions relative to the assigned claim files. Acts as a coach to members of the workers compensation unit and responsible for supervision of the support staff. This individual will Manages Workers Compensation unit in Mangers absence. Duties and Responsibilities: Provides direct supervision of support staff. Performs new employee orientation for team members. Assists staff in learning new procedures and tasks. Investigates assigned claims on a timely basis. Initiates three point contact with insured, claimant, and attending physician. Makes coverage determination. Conducts investigations into compensability, subrogation, and other issues. Secures recorded statements if needed. Assigned and directs independent outside adjusters. Sets initial reserves based on evaluation of file exposure. Reviews file periodically and sets reserves for indemnity and medical exposure. Establishes reserves up to $50,000 authority level. Directs and responds to legal counsel. Conducts litigation management. Reviews medical bills for charges and relation to accident. Makes compensability determinations. Negotiates settlements. Investigates potential offsets including subrogation, second injury, and apportionment. Documents file activities in a timely fashion in the Image Right system. Conducts investigation on potential fraud cases. Provides direct supervision to claims administration staff members for workers compensation claims administration and managed care. Assures statutory compliance for all files assigned. Interfaces with company agents, loss control, and underwriting departments. Establishes target dates for return to work. Performs claim evaluations at established intervals to ensure reserve adequacy. Sets independent medical examinations. Qualifications Bachelors degree. CPCU or other insurance designations A + 5+ years experience working in workers compensation claims