About PRISM

Supervising Senior Workers' Compensation Specialist

Job Description:

The Supervising Senior Workers’ Compensation Claims Specialist will, under the direction of the Workers’ Compensation Claims Manager, maintain a small case load of excess workers’ compensation claims and provide oversight of TPAs and claims processes on the primary claims in our Primary Workers’ Compensation (PWC) program and the Excess Workers’ Compensation Program (EWC). The Supervising Senior Workers’ Compensation Claims Specialist will assist the EIA members, staff, legal representatives, and associated personnel with the discovery and settlement of claims; report cases with potential exposure above EIA coverage to requisite carriers; update information concerning claims and maintain claims in a paperless environment; prepare correspondence; contact member agencies concerning claims status and information; and do related work as required.

The Supervising Senior Workers’ Compensation Claims Specialist will review and monitor claims for proper settlement within the member agency, EIA, and excess carrier coverage levels; contact and discuss potential defenses and settlement strategies with member agency personnel, legal representatives, settlement specialists and claims representatives; attend and provide input for settlement conferences, defense counsel meetings, and court hearings on cases within the scope of EIA coverage; review insurance policies, governing documents and program policy statements for applicability of coverage on specific claims; review and recommend modification to claims reporting procedures to ensure best availability of information for all concerned parties; ensure that member agency personnel are in compliance with reporting requirements; present cases and settlement recommendations as well as program related matters and recommendations to the Primary Workers’ Compensation and Claims Review Committees; ensure proper reporting of claims to excess carriers above the EIA coverage levels; reconcile claims for reimbursement; monitor and direct subrogation efforts; enter data into the Authority computer system and update current records as necessary; generate requisite reports from the claims system; assist with the preparation of the agenda for the Primary Workers’ Compensation and Claims Review Committee; contact member agencies and TPAs concerning the status of claims and information requirements; and attend Board and Committee meetings as required, and conferences and trainings as needed.

An important aspect of this position is enhancing the quality of claims services to our member entities. The Supervising Senior Workers’ Compensation Claims Specialist is responsible for quality assurance by performing a liaison role with TPAs and members, conducting on-going field audits as well as on-line audits of TPAs in the PWC program, participating in regular file reviews and making recommendations to management and governing committees on ways to improve claims services. A moderate amount of travel is required.

In addition to the duties above, the Supervising Senior Workers’ Compensation Specialist will supervise the Workers’ Compensation Claims Specialists and the Workers’ Compensation Claims Assistants. The Supervising Senior will provide guidance to staff, discuss claims matters with staff and members, review claim files and provide direction, and participate in the performance of the employees whom they supervise.

The ideal candidate will have a Bachelor’s Degree in directly related field or equivalent and five to seven years increasingly responsible work in directly related field; or, an equivalent combination of education and experience sufficient to successfully perform the essential duties of the job, including but not limited to:

Job Requirements:

• Previous supervisory experience and public agency claims experience is highly desirable
• Knowledge of research and evaluation techniques
• Knowledge of applicable laws and regulations
• Experience using a claims management system
•  Ability to set priorities and handle multiple projects simultaneously
• Ability to handle basic arithmetical calculations
• Ability to establish and maintain effective working relationships and good public relations with other employees, agencies, members, and the public
• Ability to conduct research, analyze and interpret information

Benefits:

A generous benefit package is provided including Public Employees Retirement System (PERS); a Section 125 Cafeteria Plan with a generous allowance from which coverage may be provided for the employee and their dependents for health, dental, and vision insurances; long-term disability and short-term disability insurance; life insurance; deferred compensation program; 13 paid holidays per year, and sick, vacation and management leaves. As a PERS participant, EIA employees are exempt from paying into Social Security, except for the Medicare portion of the cost.

Physical Requirements:

Physical requirements of this position typically include: sitting for long periods of time, reaching, grasping, kneeling, talking, hearing, seeing, repetitive motions, exerting up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently, and/or negligible amount of force constantly to move.

Special Requirements:

A valid California Driver’s license is required. Proof of auto insurance with no business exclusion is required. Possession of SIP certification issued by the State of California is required. WCCP certification is desired.

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