Claims Supervisor

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This position is ahybrid and a temp-to-hire opportunity.

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

POSITION SUMMARY: This position requires considerable interaction with the client management other Claims Examiners and other TRISTAR staff in the office; therefore consistently being at work in the office in a timely manner is inherently required of this position.

DUTIES AND RESPONSIBILITIES:

• Directly supervises examiners 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.

QUALIFICATIONS REQUIRED:

Education/Experience: Bachelors 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.
• 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 Insurance.
• Life and Disability Insurance.
• 401(k) Plan
• Paid Holidays
• Paid Time Off.
• Referral bonus.

Mental and Physical Requirements: see separate attachment for a copy of the checklist of mental and physical requirements

MENTAL AND PHYSICAL REQUIREMENTS

1. MENTAL EFFORT

1. Reasoning development:
   • Solve practical problems; variety of variables with limited standardization; interpret instructions.
   • Logical or scientific thinking to solve problems; several abstract and concrete variables.

1. Mathematical development:
   • Add subtract multiply and divide whole numbers.
   • Arithmetic calculations involving fractions decimals and percentages.

1. Language development:
   • Ability to compose original correspondence follow technical manuals and have increased communication with people in person or on the phone.
   • Ability to evaluate technical data.
   • Ability to interview job applicants.
   • Ability to give direction provide advice and feedback and reprimand as necessary.

1. PHYSICAL EFFORT

1. Physical activity required to perform the job:

Light work:

• Exerting up to 20 pounds or force occasionally.
• Exerting up to 10 pounds frequently.
• Exerting a negligible amount of force constantly to move light objects.
• Frequent sitting standing and walking.

1. Visual requirement necessary to perform the job:

• Near vision: clarity of vision at 20 inches or less.
• Mid-range vision: Clarity of vision at distances of more than 20 inches and less than 20 feet

1. PHYSICAL EFFORT (cont.)

FREQUENCY

1. Physical activity necessary to perform the job and frequency (e.g. continually frequently or occasionally):

Crouching: Crouching: Bending the body downward and forward by bending legs and spine.

Occasionally

Stooping: Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

Occasionally

Kneeling: Bending legs at knee to come to a rest on knee or knees.

Occasionally

Reaching: Extending hand(s) and arm(s) in any direction.

Occasionally

Standing: Particularly for sustained periods of time.

Occasionally

Walking: moving about on foot to accomplish tasks particularly for long distances.

Occasionally

Sitting: Body resting in an office chair while performing work particularly for long periods of time.

Frequently

Pushing: Using upper extremities to press against something with steady force in order to thrust forward downward or outward.

Occasionally

Pulling: Using upper extremities to extend force in order to drag haul or tug objects in a sustained motion.

Occasionally

Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.

Occasionally

Fingering: Picking pinching typing or otherwise working with fingers rather than with the whole hand or arm as in handling.

Frequently

Grasping: Applying pressure to an object with the fingers and palm.

Occasionally

Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately loudly or quickly.

Continually

Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication and to make fine discriminations in sound such a when making fine adjustment on machined parts.

Frequently

Repetitive Motion: Substantial movement (motions) of the wrists hands and / or fingers.

Frequently

1. WORKING CONDITIONS

Disagreeable job conditions to which the employee may be exposed and the frequency (e.g. continually frequently or occasionally) of this exposure.

None Known