Job Details:
- Level: Experienced
- Job Location: Houston Office - Houston, TX
- Position Type: Full Time
- Education Level: High School Diploma or GED
- Salary Range: $95000.00 - $105000.00 Salary/year
- Travel Percentage: None
- Job Shift: Day
- Job Category: Admin - Clerical
POSITION SUMMARY:
Under minimal supervision, oversees the daily operations of a workers’ compensation claims unit, ensuring timely, accurate, and high-quality claims handling in compliance with applicable state laws, client requirements, and company policies and procedures. Provides technical guidance, training, and performance oversight to assigned staff. Collaborates regularly with clients, management, Claims Examiners, and other TRISTAR staff across office locations to resolve claims and service issues.
DUTIES AND RESPONSIBILITIES:
- Monitors daily staffing needs and distributes caseloads as equitably as practical among direct reports.
- Reviews and approves priority payments.
- Responds to claimant and vendor concerns and facilitates timely resolution.
- Evaluates vendor effectiveness and modifies vendor panels as needed within TRISTAR and account guidelines.
- Ensures staff follows client service instructions.
- Provides claims handling coverage during examiner absences and position vacancies.
- Prepares and evaluates monthly client reports.
- Coordinates and supports internal and external audits.
- Conducts and documents internal and external educational sessions.
- Participates in client file reviews and addresses resulting action items.
- Partners with the corporate office and sales and service teams on requests for proposals (RFPs) and client service issues.
- Adheres to TRISTAR’s Supervisor Best Practice Guidelines.
- Performs other duties as assigned.
EQUIPMENT OPERATED/USED:
Computer, 10-key, printer, copier, fax machine and other office equipment.
SPECIAL EQUIPMENT OR CLOTHING:
Appropriate office attire.
Qualifications:
QUALIFICATIONS REQUIRED:
- Education/Experience: Bachelor’s degree in related field (preferred); five (5) plus years related experience; or equivalent combination of education and experience.
- Knowledge, Skills and Abilities: Strong technical knowledge of Texas workers’ compensation laws, regulations, and medical terminology. Ability to maintain a claims diary system, prioritize work, and meet strict deadlines. Strong analytical and problem-solving skills. Proficiency in Microsoft Word and Excel. Excellent written and verbal communication skills, including the ability to explain technical claims information clearly to claimants, clients, and staff. Ability to supervise, coach, and develop employees with varying levels of experience and technical ability. Strong interpersonal skills and the ability to maintain effective working relationships. Ability to manage competing priorities and remain effective under pressure. Ability to model a positive, professional attitude for direct reports. Ability to respond promptly to client requests and service needs.
Mental and Physical Requirements:
[see separate attachment for a copy of checklist of mental and physical requirements]