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Claim Supervisor, Workers Compensation

  • Job ID: 701163473
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: WKP Comm WC Claims Admin
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $32.87 to $56.12 / hour

Description

Purpose:
Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. From hospitals to our corporate office, all UPMC employees impact our mission of creating life changing medicine. To continue our tradition of excellence, we are in search for a Claim Supervisor to join this community as well.

This individual supervises assigned team members, manage claim inventories and work distribution in a Claims Unit. The Claim Supervisor assists in hiring, training and evaluating team members in the assigned unit. This role provides coaching and mentoring to team members to enhance performance, development and promote team building. In addition, this individual will identify additional training needs and monitors performance against established metrics.

Responsibilities:

 

  • Identify root causes of problems or issues and implement effective solutions. Work to resolve conflicts effectively and timely.
  • Act as a claims examiner on high cost/sensitive claims and settlements. Provide and schedule technical training to claims staff
  • Complete meaningful and timely Performance Reviews that address the strengths, weaknesses, developmental opportunities and strategies for achieving goals for the staff member.
  • Administers UPMCHS personnel policies and procedures within the unit. Interact with Human Resource Dept.
  • Recognize ways to reduce costs without negatively impacting the quality of program.
  • Understand the job duties of each staff member and how it relates to the operation.
  • Operate claims unit within budget. Monitor status of budget monthly with Claims Manager and contribute to the yearly budgetary process.
  • Establish policies and procedures for best practices for the Workers' Compensation industry. Evaluate and understand the financial performance of workers compensation program of each client.
  • Monitor claim adjuster workloads by reviewing individual claims and giving direction to ensure compliance within Workers' Compensation Act, Claim Standards and client service requirements.
  • Recognize strengths and weakness of each staff member and provide positive re-enforcement, mentoring, technical and educational support or corrective actions when appropriate.
  • Coordinate and participate in meaningful claims reviews with client as per contract requirements or at the request of client. Provide high quality customer service. Be responsive. Anticipate the needs of the customer.
  • Evaluate claims handling by adjusters and examiners to ensure acceptance or denial of the claim by bureau form issuance within the statutory requirements.
  • Coordinates and communicates regularly with other supervisors to share information, best practices, system issues, questions, training needs and team performance issues relative to process and quality standards.
  • Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.
  • Be responsive to the needs of the staff. Evaluate and respond appropriately. Be an attentive listener.
  • Complete random internal claim audits of the adjusters and examiners on a monthly basis and share results with the claim manager.
  • Assist with the initial contact of a new client and distribution of claim kit. Ensure that client details are properly set-up in Riskmaster and Tropics.
  • Contribute to positive team building, spirit and cohesiveness within claims unit(s)
  • Reviews reserve amounts on high cost/sensitive claims and claims over the authority of the Workers' Compensation Specialist.
  • Attend seminars/training for self-development, management and Disability Management. Develop and maintain working relationships with external vendors that support Work Partners. Monitor projects for quality, achieving optimal outcomes and completion.
  • Appreciate the diversity of staff.
  • Provide supervision, guidance, technical and educational support to a staff of workers' compensation adjusters handling lost-time and medical only claims, claims examiners, Nurse Case Managers and Claims Technicians in the adjudication of workers' compensation claims within the Pennsylvania Workers Compensation Act, UPMC Work Partners Claims Standards
  • Look for and apply innovative solutions to improve work processes and procedures. Empower staff to develop innovative solutions for job-related problems.
  • Engage in clear, convincing constructive communication with clients, colleagues, staff and outside vendors. Display a positive, enthusiastic influence for staff. Promote service excellence.
  • Understand UPMC Work Partners cost saving initiatives to ensure utilization in claims management activities. Review and evaluate performance of program utilizing monthly reports.
  • Complete assignments/projects as indicated by the Claims Manager and/or Senior Director efficiently, timely and without reminders.

 

Qualifications

  • Bachelor's degree and/or advanced degree (minimum 4 years of lost time experience will be considered in lieu of degree)
  • Five (5+) years of workers compensation experience (of those, a minimum of five (5) years managing cases of a complex nature)
  • Two (2) years of supervision/management experience or demonstrated leadership ability is required
  • Understanding of medical or clinical procedures is required.
  • Comprehensive knowledge of medical terminology is required.
  • Demonstrated ability to interpret workers' compensation insurance policies, coverage forms and policy language.
  • Must be self-motivated and have the ability to work independently and handle multiple priorities and deadlines simultaneously with minimal guidance
  • Excellent leadership and communication skills
  • Strong problem solving, analytical and decision making skills.
  • Must be flexible and effective at exchanging ideas and managing the creative ideas of others to improve results
  • Customer service oriented with the ability to handle emotionally charged situationsDemonstrated time management skills, ability to prioritize and identify critical tasks that deliver highest impact
  • Must possess excellent analytical, troubleshooting and problem-solving skills; sense of urgency, responsiveness and judgment to make effective decisions is required
  • Understanding of integrated disability management is preferredAbility to work effectively across a large, highly matrixed and dynamic organization
  • Willing to learn new technical, business and system skills
  • Advanced PC skills are required (including proficiency in spreadsheet applications, word processing, use of claims management and other professional databases)
  • Ability to monitor and address personnel issues that require Staff development or escalated plans for performance improvement.
  • Requirement to discuss budget plans with Senior Management.


Licensure, Certifications, and Clearances:
Licenses as required.


UPMC is an Equal Opportunity Employer/Disability/Veteran

 

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   Current UPMC employees must apply in HR Direct