12/14/1999 70162

WORKERS' COMPENSATION CLAIMS MANAGER

DEFINITION: This is administrative and management work directing the Bureau of Workers' Compensation claims management program.

An employee in this class is responsible for directing the centralized receipt, recording, and evaluation of claims reports from insurance carriers, self-insured employers, and employees on claims arising under the Workers' Compensation Act and the Occupational Disease laws. The employee is responsible for disbursing and distributing Supersedeas Fund Reimbursements and Occupational Disease payments; directing injury reporting and petition receipt and assignment functions; analyzing trends and statistical data on lost time injuries and fatalities to improve employee safety and project losses; and developing and distributing directives and instructional materials to educate individuals on the Workers' Compensation process. Supervision is exercised through subordinate managers and supervisors by the establishment of work policies, standards and objectives. Work is performed with considerable independence and is reviewed through conferences with the bureau director for overall program effectiveness and adherence to policy.

EXAMPLES OF WORK: Plans, organizes, and directs the review, processing and related record keeping of all documents and reports pertaining to worker's injury or occupational disease claims.

Directs the receipt, recording, assignment and reporting of all Workers' Compensation hearing petitions.

Ensures information concerning Workers' Compensation regulations, decisions, procedures and related issues are efficiently and effectively communicated to employers, insurance companies, and labor representatives.

Develops and implements policies and procedures concerning Supersedeas fund reimbursements, occupational disease payments, injury reporting, and indemnity payment matters.

Directs the calculations of payments, reviews and verifies applicant information, and authorizes payment for the Supersedeas Fund Reimbursement System.

Serves as principle bureau representative to insurance carriers, attorney groups, third party administrators, and employee groups regarding lawful, regulated, and procedural claims management matters.

Analyzes reports and statistical data to identify patterns of noncompliance and to determine if an investigation and/or prosecution for fraud are warranted.

Interacts with managers from other divisions within the Bureau of Workers' Compensation to coordinate and resolve policy and procedural issues.

Maintains accountability for bureau records and claims, approves the release of injury and claims related records, and testifies for the Bureau at court proceedings.

Establishes and implements administrative and operational methods and procedures, resolves complex and sensitive claim issues, and prepares confidential, statistical and related special reports and recommendations.

Directs the development and implementation of information technology within the Claims Management Division.

Educates staff, insurers, employers, and labor representatives on Workers' Compensation claims management program initiatives, policies, and procedures through consultation, seminars, and other educational forums.

Ensures responses to requests for records, data or information are in compliance with applicable laws and regulations.

Evaluates statistical data on worker injuries to explain shifts in data and recommends improvements response to identified trends.

Coordinates changes to petition assignments with the Director of Adjudication.

Participates in the performance of subordinates' work consistent with operational or organizational requirements.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of Workers' Compensation systems and their administration.

Knowledge of the principles and methods of administration and employee supervision.

Ability to plan, develop, implement and evaluate new systems and services.

Ability to analyze trends and statistical data.

Ability to plan, direct, and supervise a large, subordinate staff.

Ability to interpret collective bargaining contracts applicable to the work performed by the unit.

Ability to develop and maintain effective working relationships with federal and state government officials, insurers, employers, labor leaders and others concerned with Workers' Compensation issues.

Ability to solve difficult problems arising from the interpretation of laws and regulations affecting Workers' Compensation claims.

MINIMUM EXPERIENCE AND TRAINING: Five years of responsible and varied work in the review and interpretation of data impacting upon Workers' Compensation, including at least two years of administrative or supervisory experience in the field of Workers' Compensation, and a bachelor's degree in business administration or closely related field;

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Any equivalent combination of experience and training, including at least two years of administrative or supervisory experience in the field of Workers' Compensation.