Claims Manager - Technical Standards and Compliance | Brea, CA

PRIMARY PURPOSE : To ensure product quality and regulatory standards compliance by line-of-business; to establish policies and procedures; and to develop and train colleagues on technical components of new programs.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Establishes policies and procedures to assure compliance to best practices, claims management services standards, state regulations, and client service requirements on new programs.

• Analyzes management reports related to new program performance and quality; mentors new colleagues to improve performance as needed.

• Maintains complete understanding of new program design, processes, client expectations and partner relationships; makes recommendations for improvements; and develops best practices for disability and leave operational processes.

• Serves as subject matter expert responsible for the training of technical processes and requirements; leads training initiatives for colleagues, supervisors/managers and clients as needed.

• Leads projects focused on large process, procedural and /or compliance changes/updates; communicates changes/updates to field offices, IT, Legal and other applicable business units regarding regulatory requirements and changes.

• Plays key role in maintaining client relationships; assists in new business productions; and represents Company with specified industry groups.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travels as required.

SUPERVISORY RESPONSIBILITIES

• Administers company personnel policies in all areas and follows company staffing standards and training recommendations.

• Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.

• Provides support, guidance, leadership and motivation to promote maximum performance.

QUALIFICATIONS

Education & Licensing
Bachelor's degree from an accredited college or university or equivalent preferred.

Experience
Five (5) years of California Workers Compensation claims management experience required.

Licensing / Jurisdiction Knowledge: California workers compensation claims management experience; SIP Required.

Skills & Knowledge

• In depth knowledge of claims management, managed care and/or absence management processes and procedures

• Excellent oral and written communication, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation skills

• Ability to work in a team environment

• Ability to meet or exceed Performance Competencies