POSITION: Claims Supervisor

REPORTS TO: Branch Manager

STATUS: Exempt

POSITIONS SUPERVISED: Directly: Claims Examiners, Claims Assistants; may supervise File/Mail Clerks and Administrative Assistants

POSITION SUMMARY: Under minimal supervision, manages and directs the activity of a Public Entity (i.e. County, City, ISD, etc.) dedicated claims unit ensuring high-quality results and management of claims in compliance with state laws and company/client procedures. This position requires considerable interaction with the client, management, other Claims Adjusters, and other COMPANY staff.

DUTIES AND RESPONSIBILITIES:

• Directly supervises claims adjusters and clerical staff. Includes monitoring attendance, job performance, evaluations, and disciplinary issues.
• Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.
• Reviews and approves reserve changes, awards, and payments within Company and Client guidelines.
• Performs file reviews to monitor compliance with policies and laws.
• Establishes appropriate supervisory diaries on claim files and completes pending diaries on or before scheduled due dates.
• Prepares for claim audits, reviews audit results, and provides appropriate rebuttal feedback.
• Coordinates and leads training sessions for staff on updated laws, policies, and procedures.
• Ensures daily caseload staffing requirements are met.
• Responds to claimant and vendor concerns and issues as needed.
• Ensures client servicing instructions are being adhered to.
• Analyzes monthly client reports.
• Facilitates internal and external audits.
• Attends client file-staffing meetings in-person or telephonically.
• Other duties as assigned.

• Essential job function.

EQUIPMENT OPERATED/USED: Computer, 10-key, printer, copier, fax machine and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire, if in office.

QUALIFICATIONS REQUIRED:

Education/Experience: Bachelor’s degree in related field (preferred); three (3) to five (5) years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities:

• Technical knowledge of statutory regulations including rules and procedures relating to the City of Fresno ADR Program.
• Ability to work on a diary system, prioritize tasks and meet strict deadlines.
• Strong analytical skills.
• Proficient in Word and Excel.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
• Ability to manage employees of various skill levels.
• Excellent interpersonal skills.

Other Qualifications:

• Certifications and/or licenses as required by State regulation.

Here are some of the Benefits you can enjoy in this role:

• Medical, Dental, Vision, Disability & Life Insurance
• 401(k) plan
• Paid time off
• Paid holidays