Branch Manager- Philadelphia, PA

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Job description

POSITION: Branch Manager

COMPANY: TRISTAR Claims Management Services, Inc.

DEPARTMENT: Workers' Compensation Branch Operations- Philadelphia, PA 760400

REPORTS TO: Vice President, Regional Manager

STATUS: Exempt

DATE PREPARED: May 2021


POSITIONS SUPERVISED: Directly: Claims Supervisors; Indirectly: All positions under the supervisory level including Claims Examiners, Claims Assistants and support staff.


POSITION SUMMARY: Under minimal supervision directs overall operations of Branch Office which includes managing staff and supervisors in all aspects of their technical performance and compliance with TRISTAR policies and procedures and operating within established financial restraints. Maintains effective communication with clients to ensure contract compliance and provide excellent customer service.

DUTIES AND RESPONSIBILITIES:

• Responsible for the overall operation of the office.*
• Develops and maintains strong working relationships with client in order to ensure their

client servicing expectations and/or needs are being met.*

• Manages the claims staff to ensure compliance with client contracts.*
• Ensures compliance with corporate and client guidelines regarding claims handling

procedures.*

• Actively participates in the preparation of an annual budget and manage branch

operations within such budgeted financial restraints.*

• Prepares quarterly operational reports for Home Office commenting on budget

compliance and productivity.*

• Prepares and ensures distribution of standard monthly reports.*
• Provides ad hoc reports, as may be required, at client's request.*
• Coordinates and prepares for internal and external audits.*
• Responds to audit reviews and develop and implement corrective action plans as may

be required.*

• Oversees supervisor work product and diary compliance.*
• Monitors client trust accounts for funding adequacy.*
• Responsible for all personnel actions including hiring, performance reviews, corrective

action plans and terminations.

• Coordinates information flow, as necessary, to Home Office departments, such as, I.T.,

Human Resources, Accounting and Sales.

• Conducts regular staff training sessions as may be required, independently, and/or as

directed by Home Office.*

• Assists Home Office and sales/service team with RFP's, client service issues or new

client presentations.

• Maintains visibility in the industry by supporting and attending industry sponsored

functions, speaking engagements and educational / teaching opportunities.

• Manages office functions that support claims administration.
• Specific responsibilities for the clients to include monthly monitoring of client service and account management

HR duties

• Annual staff reviews; Penalty log; Interviews

Complaints

• Employees, providers, vendors, etc

TDI Inquiries

Bill Review Audit

• Medical bill processing by adjusters

Claim Audit Responses

Monthly staff training

Client Accountablility Meetings

• Claim reviews, plan for improvement of 1st TIBS

Office Supplies (Mail, copier, etc.)

• Claim Assts. cannot order supplies, equip., etc.

Conversion discrepencies

• Vendor payments, legal bills,

Funds Management Adjustments

Vendor Management

MWBE Compliance

504 Complaints, Nominations & Reviews

Daily Check Register

Diaries for over $250,000 (excess & incurred)

QA & Performance Based Oversight Compliance Reviews

Complex Claim Reviews


EQUIPMENT OPERATED/USED: Computer, 10-key, printer, copier, fax machine and other office equipment.


SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.
QUALIFICATIONS REQUIRED:

Education/Experience: High school diploma or GED required; Bachelor's degree in related field (preferred); ten (10) years related experience in managing/supervising workers compensation claims; or equivalent combination of education and experience.

Knowledge, Skills and Abilities:

• Exceptionally strong technical claims handling skills and knowledge of workers' compensation laws.
• Experience in supervising claims operations.
• Ability to prioritize multiple tasks and meet strict deadlines.
• Experience with, or the ability to quickly grasp, the financial issues involved in operating a branch office.
• Computer literacy in Word, Excel and PowerPoint and claims information systems.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to read, analyze and interpret claims loss reports.
• Effectively present information and respond to questions from corporate office, clients, vendors and staff.
• Ability to manage diverse staff.

MENTAL AND PHYSICAL REQUIREMENTS

• 
  MENTAL EFFORT

• Reasoning development::

Follow one- or two-step instructions; routine, repetitive task.

Carry out detail but uninvolved written or verbal instructions; deal with a few concrete
variables.

Follow written, verbal, or diagrammatic instructions; several concrete variables.

Solve practical problems; variety of variables with limited standardization; interpret instructions.

X Logical or scientific thinking to solve problems; several abstract and concrete variables.

Wide range of intellectual and practical problems; comprehend most obscure concepts.

• Mathematical development:

Simple additional and subtraction; copying figures, counting, and recording.

Add, subtract, multiply, and divide whole numbers.

X Arithmetic calculations involving fractions, decimals, and percentages.

Arithmetic, algebraic, and geometric calculations.

__ Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.

• Language development:

Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.

Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.

Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.

Ability to compose original correspondence, follow technical manuals, and have increased contact with people.

X Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

• 
  PHYSICAL EFFORT

• Physical activity required to perform the job:

Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

X Light work:

• Exerting up to 20 pounds of force occasionally
• Exerting up to 10 pounds frequently
• Exerting a negligible amount of force constantly to move objects

(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).

Medium work:

• Exerting up to 50 pounds of force occasionally
• Exerting up to 20 pounds of force frequently
• Exerting up to 10 pounds of force constantly to move objects

Heavy work:

• Exerting up to 100 pounds of force occasionally
• Exerting up to 50 pounds of force frequently
• Exerting up to 20 pounds of force constantly to move objects

Very heavy work:

• Exerting in excess of 100 pounds of force occasionally
• Exerting in excess of 50 pounds of force constantly to move objects
• Exerting in excess of 20 pounds of force constantly to move objects

• Visual requirements necessary to perform the job:

Far vision: clarity of vision at 20 feet or more

X Near vision: clarity of vision at 20 inches or less

X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet

Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are

Color vision: ability to identify and distinguish colors

Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point

• 
  PHYSICAL EFFORT (cont.)

FREQUENCY

• Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):

Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.
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