This position is responsible for the management of claim operations for Illinois Public Risk Fund. Responsibilities include the supervision and coordination of the claims team and the claim handling of workers’ compensation claims. The position is also responsible for ensuring the proper and efficient handling of claims and gathering of data on claims for both record keeping, loss forecasting, and estimating the financial value of claims.
Essential Duties & Responsibilities:
Manage the hiring, training, and performance of claims team members.
Monitor team compliance with IPRF claims handling policies and procedures, state/federal statutes and regulations, and relative case law.
Participate in claim file reviews with insured Members.
Conduct roundtable sessions on questionable, complex and catastrophic claims and claims that exceed approval authority for reserves or settlement.
Oversee claims handling activities including the determination of coverage eligibility; coordination of claims-related activities and processes through resolution of the claim (claim reporting, investigating, loss forecasting, claim and defense strategizing) and claim file maintenance.
Direct the evaluation and establishment of reserves to ensure reserves are being set within the established reserving protocols and reserve authority.
Direct claims activities necessary to achieve IPRF’s goals and objectives.
Develop and implement workflow processes to ensure efficiencies and provide oversight of individual caseloads, as appropriate.
Conduct monthly claim audits to validate reserving practices and claims handling of claims advocates.
Perform quarterly claim reviews with the claims management team on long tail and complex claims to develop claim closure strategies.
Conduct claim file reviews as specified in the IPRF SOPs.
Review costs associated with claims handling and develop strategies to improve performance.
Identify and report injury and claim trends to IPRF.
Maintain, develop and update process procedures regarding tasks specific to various claims positions.
Monitor the performance of 3rd party claims vendors for efficiency, usage, and proper billing.
Produce monthly/quarterly/annual claim reports to the IPRF Board.
Develop claim-related presentation materials for applicable meetings.
Advise IPRF on recommended program changes and improvements and developments in the claims industry or government legislation.
19. Performs other duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent oral and written communication skills.
Initiative to set and achieve performance goals.
Good analytic and negotiation skills.
Ability to cope with job pressures in a constantly changing environment.
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with minimum supervision.
Discretion and confidentiality required.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
Bachelor’s Degree in Business Administrative, Management, Finance, Insurance or other related field.
A minimum of five years of direct experience administering workers’ compensation claims within a risk management department, insurance brokerage firm, third-party adjusting firm or insurance company is required.
Knowledge of workers’ compensation coverages and Illinois workers’ compensation laws.
Five years supervisory experience required.
Proficient with Microsoft Office programs.
Certificates, Licenses, Registrations
AIC, CPCU or ARM Designation preferred.
About Illinois Public Risk Fund
Illinois Workers' Compensation Intergovernmental Pool