Claims Manager - Workers Compensation

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This is a Stanford Health Care job.
A Brief Overview
Under the direction of the Director, Claims & Litigation Strategy, the Claims Manager oversees the workers' compensation claims program for Stanford Health Care, Stanford Health Care Tri-Valley, and Stanford Children's Health. The Claims Manager acts as the primary liaison with the third-party administrator (TPA) to ensure proper claims handling and with internal partners to evaluate and reduce work-related injuries.
Locations
Stanford Health Care
What you will do

• Responsible for oversight of all TPA activities to ensure efficient and cost-effective claims handling in accordance with hospital policies and procedures and the applicable service agreement. Review reserves, settlement activity, and claims costs. Participate in periodic claim reviews and provide substantive input regarding claim strategy.

• Participate in negotiation of TPA contracts.

• Serve as liaison with external departments, including Human Resources, Workforce Health and Wellness, and Environmental Health & Safety to coordinate issues impacting claim resolution and injury/illness prevention. Participate in periodic committee meetings as warranted. Provide training related to claims workflow and processes.

• Responsible for collection and analysis of claims data. Create reports and disseminate claims data to stakeholders. Evaluate trends to support loss prevention.

• Ensure timely and accurate processing of all claim invoices.

Education Qualifications

• Bachelor’s degree in a work-related field/discipline from an accredited college or university.

Experience Qualifications

• Minimum five (5) years of progressively responsible and directly-related work experience.

• Claims Practitioner in Workers’ Compensation (CPWC) certification preferred.

Required Knowledge, Skills and Abilities

• Ability to analyze and develop solutions to complex problems.

• Ability to apply judgment and informed decisions.

• Ability to communicate effectively in written and verbal formats including summarizing data and presenting results.

• Ability to establish and maintain effective working relationships.

• Ability to work effectively both as a team player and leader.

• Knowledge of computer systems and software used in functional area.

• Knowledge of local, state and federal regulatory requirement related to the functional area.

• Knowledge of medical terms, concepts and practice.

Licenses and Certifications

• None

These principles apply to ALL employees:
SHC Commitment to Providing an Exceptional Patient & Family Experience
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.