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Career Story: Workers' Comp Claims Manager For An Insurance Company

Workers' Comp Claims Manager For An Insurance Company

Job Title: Claims Manager

Type of Company: My company is handles workers' compensation claims for one of America's largest industrial combines.

Education: 1 year of college

Previous Experience: I started as a legal secretary, went into group health insurance and that led to handling workers' compensation claims as a lifetime career. I now manage a team of ten adjusters.

Job Tasks: I currently supervise ten support staff within my office, participate in program-wide initiatives to improve the level of service to our client and am responsible for meeting specific yearly goals as set forth by our company and our client. We investigate and determine compensability of the claims that are submitted to us, deliver wage and medical benefits to our client's employees and coordinate the return to work of injured employees. My subordinates have to be trained to know the Workers Compensation law in over 43 states, and must be able to direct the handling of litigated claims and know how to detect and report fraudulent claims. They are expected to understand medical terminology and treatment protocols and foresee potentially large exposure claims based on the type of injury or illness identified by the treating physicians. I am responsible for auditing their work for proper wage and medical benefits payments, application of the specific workers' comp. laws in the jurisdictions they handle and for the appropriate level of customer service. In addition to this, I oversee the telephone unit for quality purposes and customer satisfaction ratings. I am also required to do yearly performance appraisals on my unit, and train and update my existing unit on any changes in the law or company policy and procedures.

Best and Worst Parts of the Job: The best parts of the job are working with a small group of colleagues and seeing individuals reach their potential in different areas. Some are especially good at details and others excel in customer service. It is rewarding to me as a team leader to know that the training I have given is assisting people to move forward in their careers. I try to develop the unit into a self-directed team, so that its members can work an issue through to resolution without constant supervision.

The worst part of the job is seeing someone' selfish personal agenda affect morale in the office.

Job Tips:
1. Be willing to learn, study and listen. We deal with many walks of life every day and it requires great people skills.

2. Never be afraid to ask a question if you don't have an answer. There are so many legal, medical, and analytical experts, all you have to do is ask.

3. You must have a positive personality to handle this work: dealing with injured people, disgruntled employees, lawyers and doctors!

Additional Thoughts: One of the best ways to advance in the insurance business is to take the required insurance courses for accreditation early on. But being book smart alone won't be enough; you need to have exceptional people skills and be able to detect situations that need to be investigated more thoroughly.

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