Manager, Claims Administration

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee all daily transactional activities associated with medical claims.

• Directly supervise claims administrative personnel and evaluate solutions for effective claims handling.

• Manage medical claims processing for FMLA, ADA, STD, LTD, Workers’ Compensation, and modified duty restrictions.

• Collaborate with external Third Party Claim Administrators and internal Claims Staff to coordinate leave and return-to-work strategies.

• Address and triage inquiries from external Claim Administrators in accordance with WC Charter and TPA Customer Service Guidelines.

• Organize WC meetings and present cases to the corporate Workers’ Compensation Settlement Committee.

• Supervise Claims Examiner management of Workers’ Compensation and Disability intranet sites.

• Ensure annual renewal of WC posters and panel cards.

• Manage WC job offer letters in compliance with jurisdictional regulations.

• Oversee WC document management, including subpoenas, wage requests, and settlements/SAGR to Compliance.

• Facilitate alternative medical leave options when Workers’ Compensation claims are rejected.

• Develop policies and procedures to ensure efficient service delivery to employees.

• Establish effective controls with business units.

• Identify opportunities for process integration and streamlining.

• Provide newly acquired entities with claims processes and support integration and acquisition-related claim matters.

• Execute system changes to encourage positive claims performance.

• Collaborate with the Prevention of Critical Injury team to address cases.

• Complete special projects as assigned.

• Travel approximately 5% as required.

⛳️ Requirements

• 8–10 years of experience in disability management.

• Bachelor’s degree.

• Familiarity with both insourced and outsourced program models.

• At least 5 recent years of team management experience.

• Experience in Workers’ Compensation.

• Background in case management.

• Proficiency in Workday.

• Workers’ Compensation certification is preferred but not mandatory.

• Case Management certification is preferred but not mandatory.

• Previous business experience is essential.

• Strong working knowledge of Microsoft Windows software applications.

• Administrative skills in benefit administration or similar fields.

• Excellent skills in computer applications.

• Proven problem-solving abilities.

• Strong negotiation skills.

• Comprehensive understanding of current plans and practices, including subsidiary plans and practices.

• Ability to maintain objectivity when addressing unit administrator and employee claimant interests.

• Exceptional written and verbal communication skills suitable for counseling and meeting presentations.

• Strong interpersonal skills with the ability to engage with all levels of management and employees on sensitive and emotional matters.

🏝️ Benefits

• Opportunities for career growth and development.

• An inclusive environment that values diverse perspectives and ideas.

• Unique and challenging opportunities to contribute to the success of a transforming organization.

• Comprehensive global benefits including PB Benefits and Wellbeing Programs.