WC Supervisor

PRISM is a joint powers authority of California public entities, which was established in 1979 to provide insurance and risk management services to California’s counties. Since then, our membership has expanded beyond the counties to include numerous other public agencies such as cities, schools, joint powers authorities, fire districts, etc.

PRISM operates various risk-sharing pools, which provide insurance and risk management services to its members for lines of business including workers’ compensation, general liability, property, medical malpractice, and employee benefits.

The Supervising Senior Workers’ Compensation Claims Specialist will, under the direction of the Workers’ Compensation Claims Manager, maintain a small caseload of excess workers’ compensation claims along with providing oversight of TPAs and claims processes on the primary claims in our Primary Workers’ Compensation (PWC) program and the Excess Workers’ Compensation (EWC) program. The Supervising Senior Workers’ Compensation Claims Specialist will assist the PRISM members, staff, legal representatives, and associated personnel with the discovery and settlement of claims; report cases with potential exposure above PRISM’s coverage to requisite carriers; update information concerning claims and maintain claims in a paperless environment; prepare correspondence; contact member agencies concerning claims status and information; and do related work as required.

The Supervising Senior Workers’ Compensation Claims Specialist will review and monitor claims for proper settlement within the member agency, PRISM, and excess carrier coverage levels; contact and discuss potential defenses and settlement strategies with member agency personnel, legal representatives, settlement specialists and claims representatives; attend and provide input for settlement conferences, defense counsel meetings, and court hearings on cases within the scope of PRISM coverage; review insurance policies, governing documents and program policy statements for applicability of coverage on specific claims; review and recommend modification to claims reporting procedures to ensure best availability of information for all concerned parties; ensure that member agency personnel are in compliance with reporting requirements; present cases and settlement recommendations as well as program related matters and recommendations to the Primary Workers’ Compensation and Claims Review Committees; ensure proper reporting of claims to excess carriers above the PRISM coverage levels; reconcile claims for reimbursement; monitor and direct subrogation efforts; enter data into the Authority computer system and update current records as necessary; generate requisite reports from the claims system; assist with the preparation of the agenda for the Primary Workers’ Compensation and Claims Review Committee; contact member agencies and TPAs concerning the status of claims and information requirements; and attend Board and Committee meetings as required, and conferences and trainings as needed.

An important aspect of this position is enhancing the quality of claims services to our member entities. The Supervising Senior Workers’ Compensation Claims Specialist is responsible for quality assurance by performing a liaison role with TPAs and members, conducting ongoing field audits as well as online audits of TPAs in the PWC program, participating in regular file reviews and making recommendations to management and governing committees on ways to improve claims services. A moderate amount of travel is required.

In addition to the duties above, the Supervising Senior Workers’ Compensation Specialist will supervise the Workers’ Compensation Claims Specialists and the Workers’ Compensation Claims Assistants. The Supervising Senior will provide guidance to staff, discuss claims matters with staff and members, review claim files and provide direction, and participate in the performance of the employees whom they supervise. The Supervising Senior Workers’ Compensation Specialist is responsible for fostering good relationships within their assigned team and the department, along with providing mentorship on various tasks.

The ideal candidate will have a Bachelor’s Degree in directly related field or equivalent and five years increasingly responsible work in directly related field; or, an equivalent combination of education and experience sufficient to successfully perform the essential duties of the job, including but not limited to:

• Prior supervisory experience
• Ability to motivate and promote teamwork
• Ability to foster and maintain a collaborative work environment
• Ability to mentor personnel within the claims team
• Ability to add value to the claims processes, outcomes and collaboration with the members and/or TPAs
• Experience with personnel issues and performance evaluations
• Proficient in Microsoft Office including Word and Excel
• Experience working with various claim systems
• Ability to set priorities and handle multiple projects simultaneously
• Ability to handle basic arithmetical calculations
• Ability to communicate, both verbally and written, in a clear, concise, effective and respectful manner
• Ability to conduct research, analyze and interpret information
• Ability to establish and maintain effective working relationships and good public relations with other employees, agencies, members, and the public
• Knowledge of applicable workers’ compensation laws and regulations, including but not limited to application of the WC Act, calculations of permanent disability and/or life pension benefits, knowledge of structured settlements, knowledge of CMS/MSA requirements, etc.
• Knowledge of research and evaluation techniques
• Completion of specialized educational training and courses related to insurance claims adjusting, reporting, settlement, and management are highly desirable
• Public agency claims experience is highly desirable

Licensing Requirements
A valid California Driver’s license is required. Proof of auto insurance with no business exclusion is required. Possession of SIP certification issued by the State of California is required. WCCP certification is desired.

Physical Requirements
Physical requirements of this position typically include: sitting for long periods of time, reaching, grasping, kneeling, talking, hearing, seeing, repetitive motions, exerting up to 30 pounds of force occasionally and/or up to 10 pounds of force frequently, and/or negligible amount of force constantly to move. Occasional travel may be required.

The Supervising Senior Workers’ Compensation Claims Specialist will, under the direction of the Workers’ Compensation Claims Manager, maintain a small caseload of excess workers’ compensation claims along with providing oversight of TPAs and claims processes on the primary claims in our Primary Workers’ Compensation (PWC) program and the Excess Workers’ Compensation (EWC) program. The Supervising Senior Workers’ Compensation Claims Specialist will assist the PRISM members, staff, legal representatives, and associated personnel with the discovery and settlement of claims; report cases with potential exposure above PRISM’s coverage to requisite carriers; update information concerning claims and maintain claims in a paperless environment; prepare correspondence; contact member agencies concerning claims status and information; and do related work as required.

The Supervising Senior Workers’ Compensation Claims Specialist will review and monitor claims for proper settlement within the member agency, PRISM, and excess carrier coverage levels; contact and discuss potential defenses and settlement strategies with member agency personnel, legal representatives, settlement specialists and claims representatives; attend and provide input for settlement conferences, defense counsel meetings, and court hearings on cases within the scope of PRISM coverage; review insurance policies, governing documents and program policy statements for applicability of coverage on specific claims; review and recommend modification to claims reporting procedures to ensure best availability of information for all concerned parties; ensure that member agency personnel are in compliance with reporting requirements; present cases and settlement recommendations as well as program related matters and recommendations to the Primary Workers’ Compensation and Claims Review Committees; ensure proper reporting of claims to excess carriers above the PRISM coverage levels; reconcile claims for reimbursement; monitor and direct subrogation efforts; enter data into computer system and update current records as necessary; generate requisite reports from the claims system; assist with the preparation of the agenda for the Primary Workers’ Compensation and Claims Review Committee; contact member agencies and TPAs concerning the status of claims and information requirements; and attend Board and Committee meetings as required, and conferences and trainings as needed.

An important aspect of this position is enhancing the quality of claims services to our member entities. The Supervising Senior Workers’ Compensation Claims Specialist is responsible for quality assurance by performing a liaison role with TPAs and members, conducting ongoing field audits as well as online audits of TPAs in the PWC program, participating in regular file reviews and making recommendations to management and governing committees on ways to improve claims services. A moderate amount of travel is required.

In addition to the duties above, the Supervising Senior Workers’ Compensation Specialist will supervise the Workers’ Compensation Claims Specialists and the Workers’ Compensation Claims Assistants. The Supervising Senior will provide guidance to staff, discuss claims matters with staff and members, review claim files and provide direction, and participate in the performance of the employees whom they supervise. The Supervising Senior Workers’ Compensation Specialist is responsible for fostering good relationships within their assigned team and the department, along with providing mentorship on various tasks.

Salary and Benefits
A generous benefit package is provided including Public Employees Retirement (PERS) health benefits, dental, vision, long-term disability, short-term disability, life insurance, PERS retirement, deferred compensation program, sick leave, vacation leave and section 125 cafeteria benefits. PRISM employees do not pay into Social Security except for the Medicare portion of the cost.

We are seeking candidates who can fulfill this position through a hybrid work model.