Claims Management and Administration (50%)
· Claims Processing: Communication with TPA on member or broker requests and review of incoming mail for claims action.
· Documentation: Maintain comprehensive files, correspondence, and documentation in compliance with regulatory requirements and organizational policies.
· Quality Assurance: Conduct regular audits of claim handling processes to ensure consistency and compliance. Review periodic reporting to ensure service instructions are being adhered to.
· Customer Service: Coordinate claims summary and communication with brokers on claim status or employment changes.
· Vendor Management: Update claims administrator on membership changes and answer claim related questions.
· Coverage/Policy Management: Evaluate claims for excess reporting, complete quarterly review to ensure excess reporting has been completed. Manage deductibles due from members, as well as identify and track to carrier limits and contribution/retention levels. Develop and maintain carrier coverage layers for all policy years and communicate with TPA on renewals.
Risk Management and Safety (25%)
· Risk Assessment: Participates in the analysis of claims data to determine where loss control efforts should be focused
· Safety Training: Participate in development and delivery of safety training programs and educational materials
· Loss Prevention: Analyze loss trends and develop targeted prevention strategies
· Incident Investigation: Assist with workplace incident investigations and root cause analysis
Stakeholder Relations and Communication (25%)
· Member Services: Serve as point of contact for member organizations on workers compensation and auto insurance claim matters
· Education and Training: Participate in development of workshops, seminars, and training sessions for nonprofit staff and leadership
· Communication: Prepare and present reports to senior leadership, member organizations, and external stakeholders. Assist in board administration, meeting agenda and minutes.
· Collaboration: Work closely with internal teams including human resources, legal, and finance departments
· Customer Service: Provide exceptional service to injured workers, employers, and other stakeholders
· Relationship Building: Maintain professional relationships with industry partners and regulatory agencies
· Develop and maintain a Claims Dashboard to provide periodic reports to members on their loss history and identify trends for discussion with members, brokers and vendors.
Required Knowledge, Skills, and Abilities
Technical Knowledge
· Understanding of insurance laws, regulations, and procedures
· Knowledge of insurance principles, claims management, and risk assessment
· Familiarity with occupational health and safety regulations (OSHA)
· Knowledge of nonprofit sector operations and challenges
· Proficiency in industry-standard claims management software, documentation systems
Skills and Abilities
· Strong analytical and problem-solving capabilities
· Excellent written and verbal communication skills
· Ability to negotiate effectively and resolve conflicts
· Detail-oriented with strong organizational skills
· Ability to work independently and manage multiple priorities
· Strong customer service orientation
· Ability to maintain confidentiality and handle sensitive information
Interpersonal Skills
· Empathy and compassion when working with injured workers
· Professional demeanor in all interactions
· Ability to work collaboratively with diverse stakeholders
· Cultural sensitivity and awareness
· Conflict resolution and mediation skills
· Presentation and public speaking abilities
Minimum Qualifications
Education
· HS diploma plus 5 years of work experience
· College degree preferred, or AIC Certification, or comparable industry designation
· California Self Insurance Qualified Administrator certification required
· Ability to analyze data and arrive at reasonable, supportable conclusions
Experience
· 5 years of experience with account management, claim supervision, insurance terminology, policies/contracts and other related processes and procedures
· Understanding and knowledge of Alternative Risk Transfer programs
· General knowledge of Microsoft Office programs
Licenses and Certifications
· Valid driver's license
Physical Requirements
· Ability to sit for extended periods while reviewing claims and documentation
· Ability to travel to member organization locations and to meetings and conferences (up to 10% travel)
· Ability to lift and carry files and materials up to 25 pounds
Work Environment
· Professional office environment with moderate noise levels
· Occasional exposure to stressful situations involving injured workers
· Regular interaction with members, external stakeholders and vendors
· Standard business hours with occasional evening or weekend work as needed
· Travel by car and plane required, including overnight stays
Pay: $85,000.00 - $100,000.00 per year
Benefits:
• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Paid time off
• Professional development assistance
• Vision insurance
Application Question(s):
• Do you have your California Self Insurance Qualified Administrator certification?
Education:
• High school or equivalent (Preferred)
Experience:
• account mngmt, claim supervision & insurance terminology: 5 years (Required)
• Alternative Risk Transfer programs: 2 years (Required)
Work Location: In person