This is a Remote position

POSITIONS SUPERVISED: : Directly: Claims Examiners, Claims Assistants; may supervise File/Mail Clerks, Data Entry Clerk, Receptionist, Administrative Clerk and Administrative Assistant. Focus on New York Automobile claims with governmental exposure

 

POSITION SUMMARY: Under minimal supervision manages and directs the activity of the claims unit ensuring high-quality results and management of claims in compliance with state laws and company procedures, including Article 51 – New York State No-Fault law and New York Insurance Department Regulation No. 68.

 

This position requires considerable interaction with NYS Office of General Services, management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being available, 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 guidelines up to reserve authority of $250,000.00 and payment authority of $10,000 Performs file reviews to monitor compliance with policies and laws.*   This is completed file by file, monthly reviews as required by client and agency file reviews. Coordinates and leads training sessions for staff on updated laws, policies and procedures.* Ensures daily caseload staffing requirements are met.* Supervises and approves priority payments. Responds to claimant and vendor concerns and issues as needed.* Monitors effectiveness of vendors and modifies panels as needed.* Ensures client servicing instructions are being adhered to.* Provides coverage for examiner vacancies due to vacation or vacancies.*

DUTIES AND RESPONSIBILITIES, continued

Prepares and evaluates monthly client reports.* Facilitates internal and external audits.* Conducts and documents in-house and outside educational sessions. Attends client file reviews. Partners with corporate office and sales/service team for RFP’s and client service issues. 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.