Branch Manager

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 branch office.
• Develops and maintains strong working relationships with clients 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, Loss Control 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.

QUALIFICATIONS REQUIRED:

• Education/Experience: Bachelor’s degree in related field; five (5) to ten (10) years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities:

• Exceptionally strong technical claims handling skills and knowledge of state workers’ compensation laws.
• Experience in supervising claims operations.
• Ability to prioritize multiple tasks and meet strict deadlines.
• Experience with, or the ability to quickly grasp, the financial issues involved in operating a branch office.
• Computer literacy in Word, Excel and PowerPoint and claims information systems.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to read, analyze and interpret claims loss reports.
• Effectively present information and respond to questions from corporate office, clients, vendors and staff.
• Ability to manage diverse staff.

Other Qualifications:

• Certifications and/or licenses as required by State regulation.
• SIP certificate required

Rancho Santa Margarita, CA

POSITION SUMMARY:

Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

This position requires considerable interaction with claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.

DUTIES AND RESPONSIBILITIES:

• Effectively manage a caseload of 150 to 180 workers’ compensation files, including very complex claims.
• Initiate and conduct investigation in a timely manner.
• Determine compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
• Manage medical treatment and medical billing, authorizing as appropriate.
• Refer cases to outside defense counsel. Direct and manage as appropriate.
• Communicate with claimants, providers and vendors regarding claims issues.
• Compute and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
• Settle and/or finalize all claims and obtain authority as designated.
• Maintain diary system for case review and document file to reflect the status and work being performed on the file.
• Communicate appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
• Involve TRISTAR loss control staff when appropriate.
• Adhere to all Company policies and procedures.
• Conduct file reviews independently.
• Other duties as assigned.

QUALIFICATIONS REQUIRED:

Education/Experience: Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

Other Qualifications:

• Certifications and/or licenses as required by State regulation.

Signal Hill, CA

POSITION SUMMARY:

Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

This position requires considerable interaction with claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.

DUTIES AND RESPONSIBILITIES:

• Effectively manage a caseload of 150 to 180 workers’ compensation files, including very complex claims.
• Initiate and conduct investigation in a timely manner.
• Determine compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
• Manage medical treatment and medical billing, authorizing as appropriate.
• Refer cases to outside defense counsel. Direct and manage as appropriate.
• Communicate with claimants, providers and vendors regarding claims issues.
• Compute and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
• Settle and/or finalize all claims and obtain authority as designated.
• Maintain diary system for case review and document file to reflect the status and work being performed on the file.
• Communicate appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
• Involve TRISTAR loss control staff when appropriate.
• Adhere to all Company policies and procedures.
• Conduct file reviews independently.
• Other duties as assigned.

QUALIFICATIONS REQUIRED:

Education/Experience: Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

Other Qualifications:

• Certifications and/or licenses as required by State regulation.

San Antonio, TX