ADP is hiring a Claims Lead Examiner.

 

RESPONSIBILITIES:

Assist Claims Manager in monitoring the workers compensation program within the ADPTS/PEO structure. Review and resolve complaints raised by exterior business partners. Identify and track trends with specificity that could be problematic and take steps along with Claims Manager to take steps to develop processes to correct. Review and provide concurrence to T.P.A. for reserves, settlements, and other items per Special Service Instructions. Consistently consult and collaborate with T.P.A. and internal and external business partners. Ability to read data specific dashboards to orchestrate evaluation and analysis of claims to meet department and company goals. Monitor and ensure qualitative claim handling through T.P.A. and other vendor partners. Resolve escalated complaints and/or concerns by clients, risk and safety, H.R. and other internal business partners. Promotes interactive process and early return to work programs. Perform regular reviews of claims by specified criteria on diary. Provide regular reviews and provide feedback and recommendations for resolution of claim files as needed.

 

 

REQUIRED SKILLS:

 

Possesses professional communication, both written and verbal to facilitate exceptional customer service and resolution for client complaints and issues. Possesses the ability to research complex issues with internal and external parties in a professional, empathetic manner. Ability to adhere to a daily schedule and organize yourself to deal with a high volume of inbounds calls and emails requiring responses within a reasonable period of time. Excellent interpersonal and communication skills and the ability to work independently, discretely, handling information with confidentially. Innovative and successful in implementing best practices for real, measurable results in performance, cost containment and overall efficiency. Understanding of basic leave processes/law, FMLA, and other related subjects. Proficient in the use of Excel, Outlook, Word and other Office suite programs.  

 

TO SUCCEED IN THIS ROLE: Required Qualifications 

 

7-10 years of workers compensation claims experience working in a client service/customer service environment rich with the use of state-of--the art predictive modeling, and metrics, data analytic tools and HRIS and claims systems. Requires comprehensive knowledge of CA and western region state workers compensation administration, including applicable local, state and federal laws pertaining to WC insurance programs. Possesses experience evaluating and recommending approval of claims reserves and settlements, designated expenditures and recovery forfeitures as needed. Bachelor's degree or equivalent in experience

BONUS POINTS FOR THESE: Preferred Qualifications

Comprehensive knowledge of western region states with general insurance policy coverage and state case laws. Understands the ins and outs of workers compensation claims within a PEO environment.  Familiarity and use of Risktrac and Origami. Southern CA area ideal.

 

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