Supervisor 2, Claims - Military veterans preferred

Genex Service LLC


Supervisor 2, Claims

US-NJ-Egg Harbor Township

Job ID: 25-18060
Type: Regular Full-Time
# of Openings: 1
Category: Insurance & Administration
Mitchell International, Inc.

Overview

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

Be part of a team that makes a real difference.

• Plans, directs and guides the activities of a staff of adjusters in the investigation and settlement of claims to achieve timely, equitable and accurate claims processing and settlement value in a manner consistent with client expectations and which contributes to the profitability of the company.
• Manage a caseload of workers’ compensation claims in accordance with our Best Practices, Claim Standards and Client Instructions.
• Work with both the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing treatment and related information.
• Work directly with employers to facilitate a return to work, either on a full-time or modified duty basis.
• Confirm coverage and applicable insurance policy or coverage document and statutory requirements.
• Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate.
• Identify potential for disability or pension credits or offsets and apply same where appropriate.
• Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
• Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.
• Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws.
• Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
• Where litigation is filed, evaluate exposure and work with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim.
• Maintain a thorough knowledge of the litigation process and litigation management, an understanding of relevant jurisdictional laws and regulations, statutes and related revisions or changes in the law and apply to policies and procedures appropriately.
• Close all files as appropriate in a timely and complete manner.
• Maintain closing ratio as directed by management team.
• Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees’ medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.
• Comply with all excess and reinsurance reporting requirements; manage self-insured retention reporting.
• Assist Claim Manager if requested to Accept, review, provide initial handling recommendations and distribute new claims as they come into department. Provide guidance to staff on coverage, liability and damage analysis, especially on severe and complex claims.
• Assist Claim Manager if requested to conduct and oversee internal claim reviews and audits to ensure effective claims handling by adjusters.
• Attend external client meetings to present and conduct claim and program reviews.
• Attend court-related conferences, depositions, mediations, arbitrations and other meetings as needed.
• Assist Claim Manager if requested to complete monthly SCORE audits on adjuster(s).
• Assist in training of new employees and ensure ongoing training in relevant areas.
• Conduct or participate in client training and education externally as needed.
• Participate in company projects/endeavors over and above unit/client-related supervisory functions.
• Perform other duties as required.

• College degree or equivalent work experience
• 5-6 years insurance carrier/TPA claims experience
• 5-6 years minimum Workers’ Compensation claims experience preferred
• Prior supervisory/managerial experience preferred
• Ability to work independently
• Exceptional technical abilities
• Proficient with MS Excel and Word
• Computer experience with related claims software
• Excellent verbal and written communication skills
• Proven interpersonal skills capable of dealing with all levels of personnel
• Exceptional ability to multi-task
• Excellent  negotiation skills
• Superior organizational and decision making skills
• Customer-focused orientation
• Strong analytical and strategizing skills
• Expertise in  Workers’ Compensation and related claims handling practices and ability to apply same
• Deep knowledge of client and carrier claims procedures; significant understanding of self-insured retention
• Excess and reinsurance reporting
• Deep understanding of claims evaluations and exposure potential
•  Fluent in medical terminology and medical/injury treatments.
• Must possess outstanding customer service skills to interact effectively with clients, defense counsel, vendors, management and subordinates.
• Must have expertise in principles of workers’ compensation law and applicable state and federal laws, including CMS and Medicare laws.  
• Must have proven expertise in litigation management.

PI273061730