JOB TITLE: STATE WORKERS’ INSURANCE FUND ASSISTANT REGIONAL MANAGER

JOB CODE: 70353

DEFINITION: This is managerial work assisting in the direction of regional offices for the State Workers’ Insurance Fund (SWIF).

An employee in this job performs workers’ compensation claims management activities by directing and coordinating claims functions of the staff in an assigned region of SWIF. Work involves reviewing SWIF staff work for accuracy, timeliness, and completeness of assignments; and maintaining effective communication with staff, policyholders, legal counsel, and the employer community. Work is performed with considerable independence and is reviewed for effectiveness and conformance with established procedures and objectives.

EXAMPLES OF WORK: (NOTE: The examples of work are representative of the work, but every position classified to this job may not perform all examples of work listed. Conversely, this is not an all-inclusive list of work examples.)

• Oversees the work of SWIF Claims Supervisors, SWIF Complex Claims Adjusters, and other staff within the assigned region.

• Reviews staff claims work for accuracy and completeness of assignments and reviews statistical information and length of time required for completion of assignments.

• Evaluates monthly promptness of payment reports and recommends remedial actions concerning the quantity and timeliness of investigations.

• Assists the SWIF Regional Manager with implementing policies and procedures established by SWIF.

• Reviews, explains, and conducts staff training for regional office personnel on new guidelines, procedures, and changes in SWIF’s business, and any changes in the Pennsylvania Workers’ Compensation Act.

• Extends settlement authority and settles claims within applicable authority level.

• Manages the use of contracted services, including medical management, vocational rehabilitation, survelliance, transportation providers, and interpreters.

• Meets with policyholders to resolve complex compensation matters, to conduct new insured surveys, and to provide information to underwriting inquries.

• Travels to worksites to conduct investigations and meetings with policyholders.

• Performs the full range of supervisory duties.

• An employee in this job may participate in the performance of subordinates’ work consistent with operational and organizational requirements.

• Performs related work as required.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES:

• Knowledge of the methods and techniques of workers’ compensation insurance claims evaluation, investigation, and adjustment.

• Knowledge of workers’ compensation insurance principles, practices, and terminology.

• Knowledge of laws and regulations pertaining to payment of workers’ compensation claims.

• Knowledge of investigation techniques for ascertaining facts by personal contact or observation.

• Knowledge of medical terminology associated with injuries and occupational diseases.

• Knowledge of the use and functionality of Microsoft Office Suite software.

• Ability to evaluate and review workers’ injury claims to determine the appropriateness of claim reserves.

• Ability to analyze and interpret claims information.

• Ability to communicate effectively orally.

• Ability to communicate effectively in writing.

• Ability to establish and maintain effective working relationships.

FULL PERFORMANCE KNOWLEDGES, SKILLS, AND ABILITIES: (NOTE: These are expected of an employee performing the work of this job at the full performance level. These are not used for merit system evaluation or examination purposes and are not position-specific performance standards.)

• Ability to supervise and to assist in the management of a region within SWIF.

• Ability to assist in the implementation and oversight of SWIF procedure changes and policy implementation.

MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities)

• One year of experience as a State Workers’ Insurance Fund Claims Supervisor (commonwealth title);

or

• One year of experience as a State Workers’ Insurance Fund Complex Claims Adjuster (commonwealth title);

or

• One year of technical insurance industry experience in the processing, review, investigation, and payment of complex insurance claims involving catastrophic work-related injuries under state and federal laws;

or

• An equivalent combination of experience and training.