ESIS Claims Team Leader, WC

JOB DESCRIPTION

KEY OBJECTIVE:

Supervises and directs the activities of Claims Representatives in the investigation and settlement of claims to assure prompt, efficient and fair claims services.

MAJOR DUTIES & RESPONSIBILITIES:

Reviews initial notice of claim, determines extent and validity of coverage, and screens for qualification for flow process.

Determines measures to be taken in absence of coverage or questionable cases.

Assigns work to subordinate Claims Representatives.

Determines and delegates settlement authority to Claims Reps, in conjunction with Claim Vice President or Unit Manager.

Retains higher settlement authority beyond scope of subordinates; may directly settle such cases.

Refers cases beyond scope of authority to Unit Managers.

Supervises investigations, and oversees settlement or disposition of claims by assuring prompt contact of insureds and claimants, timely investigation, and equitable settlement.

Establishes loss reserves to reflect probable Company obligation; and reviews and modifies reserves as necessary.

May directly settle claims, depending on office size, territory, and workload.

Evaluates work of subordinate Claims Reps on open cases, or at periodic intervals.

Provides direction and counsel by identifying areas of improvement needed.

Initiates proceedings for subrogation or recovery.

On cases in suit, contacts and directs the activities of Claims Attorney.

Negotiates and authorizes settlement.

Participates in human resources processes affecting subordinates in assigned unit, conducts Performance Evaluations, implements training and development.

Participates in salary administration process.

Responsible for recruitment and staffing of unit as vacancies occur.

QUALIFICATIONS

MINIMUM REQUIREMENTS:

High level of technical claims knowledge and competence as evidenced by a minimum of 7 years claims handling experience in Workers Compensation in the following jurisdictions: NM, TX.

Multiple jurisdictional claims handling experience with the requisite Adjuster Licenses desired.

Ability to plan, organize and implement general business and personnel management practices as evidenced by successful completion of management and technical programs, completion of college level curriculum or equivalent related practical work experience.

Ability to lead change by addressing points of resistance at the team and/or individual level.

The ability to independently evaluate and implement claims management Best practices through coaching, training and mentoring.

Demonstrates an understanding of team building theory and the techniques of continuous quality improvement and how they apply to ongoing activities.

Strong leadership skills including the ability to coach, develop and lead team members towards successful attainment of goals and objectives

Excellent communication, negotiation and interpersonal skills to effectively interact with all levels of an organization both internal and external.

Strong analytical and ...