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This position can be remote or in office if you are close to one of our TRISTAR offices.  This position will require 10-20% travel.

 

 

POSITIONS SUPERVISED: Directly: Claims Managers/Supervisors; Indirectly:  All positions under the supervisory level including Claims Examiners, Claims Assistants and support staff.

 

 

POSITION SUMMARY:  Under minimal supervision directs overall operations of Branch Office which includes managing staff and supervisors in all aspects of their technical performance and compliance with TRISTAR policies and procedures and operating within established financial restraints. Maintains effective communication with clients to ensure contract compliance and provide excellent customer service.

 

 

DUTIES AND RESPONSIBILITIES:

• Responsible for the overall operation of the office.*

• Develops and maintains strong working relationships with client in order to ensure their

  client servicing expectations and/or needs are being met.*

• Manages the claims staff to ensure compliance with client contracts.*

• Ensures compliance with corporate and client guidelines regarding claims handling

  procedures.*

• Actively participates in the preparation of an annual budget and manage branch

  operations within such budgeted financial restraints.*

• Prepares quarterly operational reports for Home Office commenting on budget

  compliance and productivity.*

• Prepares and ensures distribution of standard monthly reports.*

• Provides ad hoc reports, as may be required, at client’s request.*

• Coordinates and prepares for internal and external audits.*

• Responds to audit reviews and develop and implement corrective action plans as may

  be required.*

• Oversees supervisor work product and diary compliance.*

• Monitors client trust accounts for funding adequacy.*

• Responsible for all personnel actions including hiring, performance reviews, corrective

  action plans and terminations.

• Coordinates information flow, as necessary, to Home Office departments, such as, I.T.,

  Human Resources, Accounting and Sales.

• Conducts regular staff training sessions as may be required, independently, and/or as

  directed by Home Office.*

• Assists Home Office and sales/service team with RFP’s, client service issues or new

  client presentations.

• Maintains visibility in the industry by supporting and attending industry sponsored

  functions, speaking engagements and educational / teaching opportunities.

• Manages office functions that support claims administration.

• Specific responsibilities for the clients to include monthly monitoring of client service and   account management

 

HR duties

 

 

 

*Annual staff reviews; Penalty log; Interviews

Complaints

 

 

 

*Employees, providers, vendors, etc

State/Insurance dept.  Inquiries

 

 

 

Bill Review Audit

 

 

 

*Medical bill processing by adjusters

Claim Audit Responses

 

 

Monthly staff training and development

 

 

Client  Meetings

 

 

*Claim reviews, Program reviews and Improvement

Office Supplies (Mail, copier, etc.)

 

 

 

Conversion discrepancies

 

 

 

*Vendor payments, legal bills,

 

Funds Management Adjustments

 

Vendor Management. Use of Strategic Business Partners

 

 

   

 

 

 

Daily Check Register

 

 

Diaries for over $250,000 (excess & incurred)

QA & Performance Based Oversight Compliance Reviews

Complex Claim Reviews