Workers Compensation Claims Supervisor

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

📋 Description

• Manage the daily operations of a workers’ compensation claims unit with minimal supervision.

• Ensure claims are handled in a timely, accurate, and high-quality manner while adhering to state laws, client requirements, and company policies.

• Directly oversee examiners and clerical personnel, including managing attendance, conducting performance evaluations, and addressing disciplinary matters.

• Participate in the interviewing, training, and personnel actions for new hires.

• Monitor staffing requirements and allocate caseloads fairly.

• Review and resolve scheduled claims issues, including initial assessments, periodic reviews, delays, and denials.

• Conduct file reviews to ensure accuracy and compliance.

• Guarantee consistent and precise claim coding.

• Prepare meeting agendas and facilitate team discussions.

• Make daily decisions related to claims strategies, action plans, payments, recoveries, and reporting.

• Generate supervisory reports to evaluate performance.

• Review and authorize reserve changes and payments in accordance with company and client guidelines.

• Establish and maintain supervisory diaries.

• Prepare for claim audits, analyze results, and provide feedback for rebuttals.

• Conduct educational and training sessions on updated laws, policies, and procedures.

• Address concerns from claimants and vendors and facilitate resolutions.

• Assess vendor performance and adjust vendor panels as necessary.

• Ensure staff adherence to client service instructions and state reporting mandates.

• Provide claims-handling support during staff absences and vacancies.

• Prepare, assess, and analyze monthly client reports.

• Coordinate and assist with internal and external audits.

• Engage in client file and claim reviews and address resultant action items.

• Collaborate with the corporate office and sales/service teams regarding RFPs and client service matters.

• Comply with TRISTAR’s Best Practices.

• Execute other duties as assigned.

⛳️ Requirements

• High School Diploma or GED as specified in the posting.

• A minimum of five (5) years of relevant experience, or a comparable mix of education and experience.

• Strong technical expertise in multi-state workers’ compensation laws, regulations, and medical terminology.

• Capability to maintain a claims diary system, prioritize tasks, and meet stringent deadlines.

• Excellent analytical and problem-solving abilities.

• Proficient in Microsoft Word and Excel.

• Outstanding written and verbal communication skills, with the ability to clearly explain technical claims information to claimants, clients, and staff.

• Ability to supervise, mentor, and develop employees with diverse levels of experience and technical skills.

• Strong interpersonal skills with the ability to cultivate effective working relationships.

• Ability to manage conflicting priorities and maintain effectiveness under pressure.

• Ability to exemplify a positive, professional demeanor to direct reports.

• Quick responsiveness to client requests and service needs.

• Certifications and/or licenses as mandated by state regulations.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with company match.

• Generous paid time off and holidays.

• Opportunities for professional development and growth.