JOB TITLE: STATE WORKERS’ INSURANCE FUND REGIONAL MANAGER

JOB CODE: 70354

DEFINITION: This is administrative and managerial work managing and overseeing the operation of a regional office in the State Workers’ Insurance Fund (SWIF).

An employee in this job performs workers’ compensation claims management activities by directing and coordinating claims functions for the assigned region of SWIF across multiple office locations. Work involves performing administrative functions of managing offices within the region and maintaining effective communication with staff, policyholders, legal counsel, and the employer community. Work is performed with considerable independence and 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 SWIF claims handling in the assigned region in accordance with the Pennsylvania Workers’ Compensation Act, the Pennsylvania Occupational Disease Act, and any other applicable statute, and by conforming to industry standards and best practices.

• Plans, coordinates, and reviews the work of the SWIF Assistant Regional Manager and staff within the assigned region, including occupation injury and disease claims, Section 601 claims, Act 46 claims, Longshore and Harbor Workers’ Compensation Act claims, fatality, and out-of-state claims.

• Oversees and monitors SWIF claims handling for the assigned region by monitoring accuracy and completeness of assignments and reviewing statistical information and length of time required for completion of assignments.

• Ensures that work is performed consistently throughout the region.

• Coordinates responses to legislative inquiries for the SWIF Director or agency executives.

• Travels to conduct meetings with regional staff members and to conduct or participate in training.

• Meets with policyholders and industry representatives to explain and interpret the provisions of Pennsylvania’s workers’ compensation laws.

• Implements policies and procedures established by the SWIF Director and agency executives.

• Reviews and explains to regional personnel new guidelines, procedures, and changes in SWIF’s business process in the applicable program areas, and any changes in the Pennsylvania Workers' Compensation Act.

• Manages the usage of contracted services, such as medical management, vocational rehabilitation, surveillance, transportation, and interpreters, by handling issues with vendors and reporting back to SWIF management.

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

• Interfaces with SWIF counsel, including contract attorneys, on pertinent claim matters, acts as a liaison with claims staff and defense counsel, and reviews all requests for appeals and refers to the Office of Chief Counsel, as appropriate.

• Maintains a thorough knowledge of the Pennsylvania workers' compensation and occupational disease laws and other applicable statutes.

• Ensures SWIF's computer system is utilized to its maximum potential within the assigned region through continuous training and interfacing with SWIF information technology staff and training coordinators.

• Assists, when necessary, in all aspects of the claims handling process in the assigned region.

• Ensures all offices conform to the policies and standard operating procedures of the State Worker’s Insurance Fund and the Department of Labor and Industry.

• Performs the full range of supervisory duties.

• An employee in this job may participate in the performance of subordinates’ work consistent with operational or 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 regulations and laws pertaining to payment of workers’ compensation claims.

• Knowledge of investigative techniques for ascertaining facts by personal contact and observation and by the examination of records.

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

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

• Ability to analyze claims information and to implement procedures and claims handling strategies.

• 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 implement, monitor, and provide feedback on procedures established by SWIF Director and agency executives.

• Ability to recognize staff deficiencies and implement corrective performance measures.

• Ability to monitor the work of vendors and recommend improvement of contracted services.

• Ability to manage administrative functions of offices within a region of SWIF.

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

• One year of experience as a State Workers’ Insurance Fund Assistant Regional Manager (commonwealth title);

or

• Two years of experience as a State Workers’ Insurance Fund Claims Supervisor or as a State Workers’ Insurance Fund Complex Claims Adjuster (both commonwealth titles);

or

• Two years of technical insurance industry experience that includes or is supplemented by one year of supervisory 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.