Claims Administrator

Claims Administrator

Summary of Position

The Claims Administrator mitigates an organization’s exposure to risk by formulating, developing, and coordinating all claims-related activities, as well as resolving bona fide claims at the least possible cost through various risk transfer techniques. Directs a program to ensure the proper and efficient handling of claims, gathering data on claims for both record keeping and loss forecasting purposes, and estimating the financial value of claims. Is also responsible for post lost reduction techniques such as salvage, subrogation, and rehabilitation.

Overall Responsibilities and Duties

·  Create, document, and maintain all claims files and claim activity.

·  Use discretion and independent judgment in making decisions related to risk, insurance, and safety.

·  Manage the relationships with third party service providers including brokers, insurer, and other TPAs.

·  Management of claim files in multiple jurisdictions, including investigating and coordination with insurance company claim adjusters and internal management through closure.

·  Continuous and timely follow-up to ensure compliance with Company protocol regarding return to work initiatives, cost controls, and employee work status.

·  Sort and process all claims related correspondence.

·  Educate, advice, and provide support to the restaurant’s Operations staff on the claims process and protocol.

·  Oversee the compilation and distribution of reports including but not limited to monthly open claims report and internal cost allocation report and related analysis.

·  Effectively interface with claims representatives, insurance broker, and internal customers (including Operations, HR, Facilities, Accounting departments).

·  Help identify, analyze, evaluate, prioritize and document key company risks.

·  Help facilitate the prioritization of risks, identification of risk owners and monitoring of risk mitigation actions.

·  Assist in evaluating how company risks can be mitigated by insurance and make recommendations regarding insurance, self-insurance, avoidance strategies, loss control projects and hazard reduction strategies.

Qualifications

Education, Training, and Work Experience

·  4+ years of equivalent work experience with claims / risk management / insurance programs (preferably in a retail setting)

·  Extensive knowledge of workers compensation laws and processes (IME, AME/QME, MPN and HCN panels)

·  Knowledge and experience using an RMIS (Risk Management Information System)

·  College degree & bilingual (English/Spanish) a plus

·  Industry accreditations, such as (ARM) Associate in Risk Management preferred

Knowledge, Skills and Abilities

·  Strong leadership, interpersonal skills and ability to interact with leaders at all levels of the organization

·  Strong insurance prowess and acumen

·  Superior problem solving and analytical skills (both quantitative and qualitative)

·  High level of perseverance to complete and understand deeper levels of analysis

·  Proficient computer skills with Microsoft Office products and the ability to compile reports to Excel

·  Has statistical knowledge, data collection, analysis, and data presentation experience

·  Detail oriented and strong organizational skills

While performing the duties of this job the employee is frequently exposed to computer terminals. The noise level and temperature is moderate. The employee has the ability to sit, stand and/or walk for up to 10 hours a day. The employee is occasionally required to stoop, bend or kneel, lift up to 40 lbs. and perform other diverse physical tasks as needed. The vision requirements include: close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

NOTE: CPK reserves the right to revise or change the position plan as the need arises. This position plan is not all inclusive of total job responsibilities nor does it constitute a written or implied contract of employment.