Regional Manager - Eastern Region Workers Compensation

Reports to: Head of TPA Claims

Summary/Objective: Oversees direct reports (6-7 Full Time direct reports) in determining coverage, compensability, benefits due; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; to identify subrogation of claims, clear and concise action plans, reserving and settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Review, assign and supervise all claim activity for designated claims to ensure compliance with company best practices, client specific handling instructions and in accordance with applicable laws.
• Responsible for oversight in assessing compensability, coverage, AWW/CR and timely payments.
• Reviews and approves settlement of claims within designated authority.
• Responsible for overseeing reserve establishment and/or oversight of reserves for designated claims within established reserve authority levels.
• Monitors necessary state filings within statutory limits.
• Oversees the litigation process; ensures timely and cost-effective claims resolution.
• Reviews vendor referrals utilized in investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Monitors and approves claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate for further review.
• Leads team manager meetings and assigns accountability for follow-up items.
• Mentors and provide ongoing training and assist in the development of claim staff.
• Review and maintain supervisory diary on claim system.
• Ovrseeing of all claim activity for specified accounts.
• Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
• Key part of the team with Team Manager/Lead to interview adjusters and provide feedback.
• Provides assistance/support to Team Manager/Lead with monthly review of adjusted workloads; notes trends and suggests adjustments when necessary.
• Participates in claim reviews both telephonic and in person as needed.
• Participates in onsite meetings with insureds.
• Collaborates with adjuster, team managers, insureds, and brokers on a regular basis.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others.
• Supports the organization and management.
• Some travel may be required.

QUALIFICATIONS

Preferred Education and Experience

Bachelor’s Degree (preferred), or equivalent experience (8-10 yrs) of adjusting experience. Knowledge in multi-state jurisdiction, is a plus. Also willing to learn additional jurisdictions. Ability to multitask, organize, prioritize, handle a fast-paced environment, and manage workload with a positive attitude and minimal supervision. Strong written and verbal communication skills, as well as attention to detail. Professional certifications as applicable to line of business is a plus.

Skills & Knowledge

• In-depth knowledge of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent negotiation skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

Competencies

Thoroughness. Technical Capacity. Problem Solving.

Work Environment

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit, frequent use of keyboard, handle or feel; occasionally stand; walk; and reach with hands and arms.

Position Type/Expected Hours of Work

This is a full-time position. Standard days and hours of work are Monday through Friday, 8:30 a.m. to 5 p.m. Additional hours required based business needs this may change. 

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Equal Opportunity Employer, M/F/D/V

Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.

Why Join Us:

At Acrisure, we’re building more than a business, we’re building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.

Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York.

Employee Benefits

We also offer our employees a comprehensive suite of benefits and perks, including:

• Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.

• Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.

• Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.

• Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.

• … and so much more!

This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.

Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting leaves@acrisure.com.

California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.

Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice.

Welcome, your new opportunity awaits you.