AmeriHealth Casualty jobs

DETAILS Claims Supervisor Department: Workers' Compensation Reports To: Division Claims Manager FLSA Status: Exempt Job Grade: 14 Career Ladder: Next step in progression could include Division Claims Manager ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for a Claims Supervisor to support our Workers Compensation office in Las Vegas on W. Lake Mead. This position allows for hybrid work from home four days a week if technical requirements are met, and one day a week (Wednesday) in office. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. This position can be worked remotely from Nevada, if technical requirements are met. As a Claims Supervisor, you'll play a pivotal role in leading and collaborating with Athens management to achieve exciting company goals, run insightful reports, and streamline processes. You'll make impactful daily claims decisions, review files for accuracy, and approve payments that exceed examiner authority. Additionally, you'll ensure top-notch file handling, accurate claims coding, and meet unit closing goals. You'll be the guiding force for your team, planning, organizing, delegating workloads, supervising daily activities, providing training, and offering valuable guidance. In client management, you'll address policy and claims issues, build and maintain strong relationships, attend key meetings, ensure compliance with client instructions, and document interactions, always acting in the client's best interest. Join us and make a difference every day! PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Claims Leadership Work with Athens management to achieve company initiatives and performance goals Consistently strive to improve and streamline current processes Authorize release of payment and settlement Make daily claims decisions regarding plan of action, handling of payment, etc. Review claim files for accuracy Run various reports with an eye for accuracy and confidentiality Approve payments and reserve increases when they rise above Examiner's authority level Work collaboratively with internal and clients' senior management as well as with attorneys to draft settlements and assist with litigation strategies Provide timely information to clients, attorneys, doctors, investigators and injured workers with strong, professional communication Discuss appropriateness of medical treatment with medical case manager Assure consistent and accurate claims coding is occurring on the team Ensure quality file handling and resolution. This includes meeting unit closing goals, verifying proper reserves, providing thorough claims analysis and guiding to correct resolution Use flexibility when working in demanding and changing situations Employee Management Effectively plan, organize and delegate workload for optimal results and to ensure time commitments are met Supervise daily activities of the team by monitoring progress, ensuring compliance with policies, and promptly addressing any issues or conflicts Identify, coordinate, coach, and perform training with staff to improve performance and increase their growth and knowledge in claims Participate in the interview process, onboarding and training of new hires Provide general guidance to the team by offering support and advice on work-related issues, fostering a positive work environment, encouraging professional development, and reviewing performance through evaluations, feedback, goal setting, and identifying areas for improvement Provide direct feedback and use sound coaching techniques to solve disciplinary or workflow problems. Manage and document employee relations issues at all levels. Work in conjunction with Human Resources to ensure performance issues are managed in a timely and consistent manner Regularly lead organized and collaborative staff unit meetings, including both remote and on-site employees Maintain an open-door policy and an approachable attitude, and foster open communication with staff Client Management Work with clients with issues regarding policies, programs and/or claims Manage existing client relationships by being accessible, making regular service calls, and proactively identifying and solving potential problems Attend client meetings, internal meetings, and workers' compensation meetings both virtual and in-person Ensure notepads and diaries are set and completed timely in accordance with client handling instructions and Athens Best Practices and have meaningful action plans and information and are concise and well-written Obtain audit results meets or exceeds best practice standards of Athens and client Display integrity and always acts in the best interest of the client Document client meeting notes in appropriate shared location Work with Management to achieve company initiatives and performance goals Work with clients with issues regarding policies, programs and/or claims Supervise daily activities of team Coordinate and perform training Interview, hire and train employees Provide general guidance to staff Review performance of staff Resolve team/workflow problems Lead staff unit meetings Attend client meetings, in-house meetings, and workers' compensation meetings Authorize release of payment and settlement Make daily claims decisions regarding plan of action, handling of payment, etc. Review claim files for accuracy Run reports Approve payments and reserve increases when they rise above Examiner's authority level Work collaboratively with Athens' Administrators and clients' senior management Provide information to clients, attorneys, doctors, investigators and injured workers Work collaboratively with attorneys to draft settlements and assist with litigation strategies Discuss appropriateness of medical treatment with medical case manager Assures consistent and accurate claims coding is occurring throughout the organization. Supervisory Responsibilities Supervising, scheduling, assigning, monitoring, and evaluating work of assigned staff are responsibilities for supervisory positions. Provide direct supervision for 6-10 employees, typically consisting of Senior Claims Examiners, Future Medical Claims Examiners, Claims Examiners, Assistant Claims Examiners and Assistant Claims Examiner Trainees. Attend on-site Leadership Summit at Athens Concord headquarters every 18 months (including overnight) Fiscal Responsibilities Review and approve direct report's monthly expense reports Ensure that all expenditures are in the best interest of the Company Use effective monitoring and reporting mechanisms to control expenses without lowering quality Search for and implement hidden cost improvements Obtain, maintain, and demonstrate an understanding of wage and hour laws as applicable for employees Ensure timely, accurate review and approval of timecards for your staff on payroll processing days. ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required Must reside in Nevada and be legally capable of administering State of Nevada workers' compensation claims Solid and in-depth knowledge of workers' compensation laws, policies, and procedures 3+ years' recent workers compensation claims handling experience at a high level 5+ years' experience in a Workers' Comp claims lead or supervisor position preferred At least 2 years Claims Supervisory experience required Proficiency in determining case value and negotiating settlements Prior Third-Party Administrator (TPA) experience preferred Understanding of medical and legal terminology Strong attention to detail and organizational skills and the ability to research and resolve problems and meet multiple deadlines and to plan and effectuate short- and long-range Company and department objectives. Proficiency at applying business and technical acumen by understanding how the business works and how technology supports business initiatives. Leverages technology for self and staff to improve efficiency. Partnering with team to ensure on time task completion; done through delegation and leading by example, executing tasks rather than just instructing them to execute tasks Handles stressful situations and deadline pressures well Must demonstrate accuracy and thoroughness in work product Effectively influences people to achieve unit and organizational objectives Must be flexible, adaptable, and positive. Exhibit passion and energy to ensure that all employees are respected and treated in a manner consistent with Athens Values. Able to plan, prioritize and organize claims workload for a unit Skilled at presenting in small and large group settings Ability to create reports as required, using the report writing tools available or creating custom documents. Skilled at developing and maintaining effective relationships with others (co-workers, customers, vendors, management, and other key stakeholders) to achieve organizational goals Embrace the leadership role and can be counted on to help senior management drive towards the desired results and to exceed goals successfully. Able to interpret information from multiple sources and draw logical conclusions; consults others based on analysis of data; able to think strategically and use data findings to consult others for improved business results. Negotiating skills Mathematical calculating skills Exercise independent judgment and analytic ability in solving complex and sensitive problems Highly developed verbal and written communication skills with strong attention to detail Computer processing skills, including the ability to leverage technology for self and staff to improve efficiency Proficient in Microsoft Office Suite Ability to type quickly, accurately and for prolonged periods Ability to learn additional computer programs ClaimsXpress program experience preferred but not required Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Valid Driver's license and availability for travel including in office file reviews and meetings APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************* This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here