Claims Manager – Workers Compensation

November 26

🏄 California – Remote

Although this job is listed in California, this company may be open to hiring remote in other states.

💵 $66 - $88 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

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Stanford Health Care

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Healthcare Insurance • Pharmaceuticals • Biotechnology

Stanford Health Care is a leading healthcare provider affiliated with Stanford University, offering a wide range of medical services, including primary, specialty, and emergency care. Known for its cutting-edge research and innovation in medicine, the facility also partners with Stanford Medicine and Stanford School of Medicine to provide top-tier medical education and research opportunities. Patient care is enhanced through their MyHealth online and mobile platforms, allowing easy access to medical records, appointment scheduling, and bill payments. Stanford Health Care is dedicated to improving health outcomes through advanced technology, personalized care, and comprehensive health services.

10,000+ employees

Founded 1991

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🧬 Biotechnology

📋 Description

• 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.

🎯 Requirements

• Bachelor’s degree in a work-related field/discipline from an accredited college or university. • Minimum five (5) years of progressively responsible and directly-related work experience. • Claims Practitioner in Workers’ Compensation (CPWC) certification preferred. • 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.

🏖️ Benefits

• SHC Commitment to Providing an Exceptional Patient & Family Experience • C-I-CARE standards for all patients and families • Equal Opportunity Employer