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The Claims Supervisor is responsible for the analysis and supervision of claim files within their units. File supervision includes: coverage analysis, conformance to file plans, reserve accuracy, effective negotiation and appropriate resolution. The Claims Supervisor is a mentor to not only the specific unit, but also the entire claim department and is available for consultation/discussion with staff as the primary responsibility. The position is responsible for staff training and development. The Claims Supervisor will work closely with other Unit Supervisors/Managers to insure the efficient and effective resolution of issues. The Claims Supervisor is charged with managing pending claims, improving file quality and controlling expenses. The Claims Supervisor will conduct the management of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. The Claims Supervisor is expected to function at a level of expertise and competency commensurate with experience, while exercising good judgment and independent discretion. The Claims Supervisor is expected to support Company goals and advance Company values.
Direct responsibilities include but are not limited to:
- Direct management of staff of 6-7 examiners and their claim files.
- Analyzes file plans.
- Approve action plans in accordance with best practices.
- Completes 24 TQR per examiner per quarter with emphasis on file quality and lost economic opportunity.
- Document the claim file of all activities taken.
- Work with the examiner throughout the life of the claim.
- Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
- Frequently communicate with all appropriate parties involved with the claim.
- Maintain professional vendor relationships.
- Actively execute appropriate claims activities to ensure consistent delivery of quality claims service.
We have a great opportnity to join the Preferred Employers Claims Team!
In this role, the Claim Assistant plays a key role in accomplishing the organization’s strategy while ensuring the ongoing satisfaction of PEI’s internal and external customers. This role provides foundational support to the department’s shared goal of providing timely medical and financial benefits to injured workers.
Job duties include administrative support, customer service and timely issue resolution. Duties are considered routine and predefined. The Claims Assistant-Support Unit must be a highly motivated team player, critical thinker and be open to constructive feedback.
Primary responsibilities include but are not limited to the following:
- Perform moderate to complex clerical work.
- Duties include but not limited to record management, payment processing, financial reconciliation, creating and mailing correspondence, scheduling medical treatment, researching and addressing customer issues.
- Act as a first point of contact for injured workers, policy holders, brokers and medical providers on high volume inbound calls, live chats and email requests.
- Timely respond to customer inquiries fulfilling needs and escalating issues as appropriate.
- Stay current with assigned diary tasks.
- Document activity and pertinent transactions within source claim and policy systems.
- Assist in training and provide support for new team members.
- Work productively and harmoniously with others on a regular basis.
- Uphold company culture and values.
- Consistently maintain professional and appropriate demeanor.
- Actively engage in company sponsored professional development opportunities.
- Perform other duties as assigned.
The Claims Operations Supervisor is responsible for the daily management of Claims Operations workflows and provides leadership and training to Claims Support and Customer Service staff to meet established departmental service standards.
This position is primarily a day-to-day production role. The Claims Operations Supervisor must show expertise in company policies and procedures in relation to Claims Operations, First Notice of Loss and Policy administration and must be able to perform all technical, administrative and customer service related tasks when needed for coverage.
This position must exhibit a high degree of competency, productivity, timeliness and accuracy. The Claims Operations Supervisor will model company core values while exercising appropriate judgment, displaying a team player attitude and effectively respond to unexpected changes or demands.
Responsibilities include but are not limited to:
- Train, mentor and supervise Support and Customer Service Unit team members.
- Ensure all support, new loss setup and policy related tasks are performed timely and accurately and departmental standards are maintained.
- Analyze operating procedures, recommend forward thinking solutions and generate ideas for continuous improvement and implement approved changes.
- Actively seek feedback to ensure processes and procedures meet internal and external customers’ needs.
- Resolve insured, broker, claimant and vendor inquiries with exceptional customer service.
- Respond to management requests for information and recommendations in an appropriate and timely manner.
- Cultivate and maintain effective working relationships with team members and department leaders.
- Complete various related tasks and projects as assigned
A great opportunity to join the Preferred Employers dynamic team as a working leader of our Risk Advisor (Safety/Loss Prevention) operations. While we have offices in San Diego & Walnut Creek, the field-focused nature of this role does allow for a remote/home based work location. Come join our innovative, inclusive, and collaborative team!
The Manager, Safety & Health will be responsible for managing and evaluating all safety & health service functions provided by the Risk Advisor staff to eliminate or reduce exposures to loss. Assists in the marketing of safety consultative services and company products in conjunction with company marketing objectives and goals.
The essential functions include, but are not limited to the following:
- Manages and coordinates assignment of Risk Advisor services, monitors consultation services provided to customers, provide support to staff to meet their responsibilities.
- Conducts performance reviews and makes salary recommendations for staff.
- Directs and provides consultative services to association customers to support Risk Advisor functions.
- Coordinates and participates in the planning and execution of workshops, seminars and meetings for customers or potential customers to develop new business for the company.
- Maintains regular communication relative to pertinent issues with other department staff and other appropriate company personnel.
- Maintains an understanding of laws, rules and regulations affecting the insurance mechanism relative to the services provided by the company.
- Analyzes staff development needs/monitors staff development & training.
- Keeps informed of innovative risk-mitigation approaches, new consultative tools and equipment used to address industry injury trends, then develops relative services to assist customers.
- Makes regular visits to existing and prospective customers for marketing purposes, as requested.
- Provides overall management leadership for the company and department.
- Will immediately report all harassing or inappropriate behavior to Human Resources.
The Manager of Sales & Distribution – Los Angeles Territory in California is responsible for:
- Targeted areas within the region known as the Los Angeles Basin. Includes region around Santa Monica/San Fernando Valley, Ventura/North LA up to Santa Barbara. Pasadena east to San Bernardino/West Riverside and all of Orange County. Also includes specific opportunities in the cities of Los Angeles/Long Beach.
- This job is all about the sales development and management of assigned agents/brokers and sales solicitation, Developing strong relations with the territory’s agents and brokers is key to success. The job involves setting in motion mutually-agreed-to sales plans and driving the necessary strategies and marketing actions needed to maximize profitable growth for Preferred Employers in this territory.
- Develop, implement and drive targeted class code sales plans with both current brokers and new brokers to meet Preferred’s profitable growth goals.
- Identify, develop, implement, and manage producer sales plans with target groups of business owners to meet Preferred’s sales goals.
- Monitor new sales, retention, rate-adequacy and commission metrics monthly to ensure premium plan goal achievement.
- Works closely with all company departments to optimize Preferred’s brand offering to the marketplace.
- This is a high-relationship type function requiring regular Zoom call time, windshield time, a high-level of communications skill, direct broker contact and direct selling contact with targeted prospects/clients.
- Job demands ongoing sales prospecting and finding qualifying business originating from the territory.
- Expectation is that candidate will operate primarily out of their company-assigned automobile, their home office with monthly visits to the company’s headquarters in San Diego or as needed from time to time.
- This job requires significant travel within the territory as required to build deep relationships with agents.
Under clinical supervision, the Utilization Review Assistant I is responsible for assisting the medical unit team with processing timely utilization review related tasks. The Utilization Review Assistant I will report directly to the Medical Unit Manager. The Utilization Review Assistant I will work closely with the Medical Unit by assisting the team with responding to requests for medical treatment within state mandated timelines. The Utilization Review Assistant I must exhibit competency, responsibility, timeliness, accuracy and critical thinking skills.
Responsibilities include but are not limited to the following:
- Assist Medical Unit team with issuing letters/notifications timely.
- Assist with submitting Utilization Reviews to the URO for coverage of the Medical Unit Clerk.
- Assist with issuing expedited letters.
- Assist with addressing authorization letters for the UR nurses.
- Carry out assigned tasks.
- Triage incoming calls to Medical Unit.
- Address requests for extension of authorization letters
- Assist with refaxing of authorization letters.
- Assist with addressing invalid RFAs.
- Assist with labeling activities in the medical queue.
- Provide status updates of RFAs sent to the Medical Unit.
- Perform other job-related duties as assigned
Interested in a career with premium audit, or want to utilize your premium audit experience to make a difference?
At Preferred Employers Insurance, we work in a collaborative, innovative environment that engages daily with other departments, focusing on quality work, and best in class service. We have a history of producing excellent results, and are looking to expand our team. Come join us as we chart our future!
The Premium Audit Analyst is responsible for reviewing and conducting final audits. The primary role of the Premium Audit Analyst will be to maintain and improve the premium audit department by performing the following duties: applying company audit guidelines as well as those of the California Workers’ Compensation Uniform Statistical Reporting Plan, conducting timely and accurate premium audits, resolving audit disputes, being an audit resource for policyholders/brokers/internal departments, performing physical (virtual) audits as assigned, and any other general duties or projects as assigned and deemed necessary.
Responsibilties include but are not limited to the following:
- Apply company audit guidelines as well as those of the California Workers’ Compensation Uniform Statistical Reporting Plan.
- Analyze final audits to ensure the appropriate premiums are being charged to the policyholders.
- Perform physical (virtual) audits as necessary.
- Provide technical expertise to other departments, such as underwriting.
- Answer customer calls including specific, detailed, audit related questions.
- Communicate necessary policy changes resulting from the final audit.
- Any other general duties or projects as assigned and deemed necessary.
The Senior Underwriter is primarily responsible for risk evaluation and pricing for new and existing business in accordance with the company’s underwriting approach and guidelines. The Senior Underwriter develops and fosters positive, professional, and effective relationships with the company’s broker partners, as well as achieves company growth and profitability objectives. This position is expected to exhibit a high level of technical expertise, while exercising sound judgment, and delivering consistent results. The Senior Underwriter is also expected to be a leader and role model within the department, helping to train and mentor less experienced staff. The Senior Underwriter is expected to be solution oriented and exhibit a strong customer experience mindset.
Responsibilities include but are not limited to the following:
- Selects new business and evaluates renewal accounts in accordance with company underwriting philosophy and guidelines.
- Works within established authority parameters and adheres to written/verbal processes and procedures.
- Demonstrates a professional, courteous attitude with brokers and other company staff. Responds quickly and ethically to all requests/issues. Assists in issue resolution and will coordinate with other departments when necessary.
- Provides accurate and thorough guidance to brokers regarding the company’s appetite philosophy and pricing guidelines.
- Monitors performance criteria, including premium and unit count goals, mix of business, production ratios for assigned brokers/product segments.
- Achieves company growth objectives by recognizing sales opportunities, soliciting desirable business, supporting company rate strategy and diligent follow-up on quoted business.
- Travels to brokers providing field underwriting and quoting as needed.
- Reviews claims activity, loss control surveys, and inspection reports for existing policies, handling as required.
- Collaborates with colleagues in Marketing/Sales to achieve shared objectives and execute company strategy.
- Determines the appropriate course of action for policy changes, delegating as appropriate to processing assistants for handling.
- Provides mentoring and training to less experienced staff members.
- Embraces the importance of the customer experience and is execution oriented.
- Uses an innovative mindset to improve the department function and achieve strategic objectives.
- Handles other projects or initiatives as assigned