Claim Data Process Manager

Emory•Atlanta, GA

13h•Onsite

About The Position

Plays a key role in protecting the financial stability of Emory University, Emory Healthcare, and its wholly owned insurance subsidiary, Clifton Casualty Insurance Co. Ltd. (CCIC) Tracks and creates monthly loss runs that track all payment and reserve-related movement for third party liability matters insured under Emory’s Liability Program Processes and monitors Emory Medical Professional, General Liability, and Network Security & Privacy indemnity and expense payments Works with CCIC manager and actuary to perform monthly reconciliation of liability loss run, insurance program accounting and performance This position is also responsible for developing claims data analytics, providing data and trends to clinical and other leadership for purposes of quality and patient safety improvements. The Claim Data Process Manager will collect data, perform statistical analysis, create dashboards/ reports and collaborate with teams including Claims, Risk, Patient Safety, Quality, and Clinical operating units. The goal is to bring awareness to claims holistically to help inform risk, patient safety and quality initiatives, ultimately to improve patient outcomes and reduce claims and claim costs.

Requirements

Bachelor's degree in a business-related field
Minimum five (5) years relevant experience
K nowledge of legal and insurance claims handling principles
Basic accounting skills , ability to navigate various data systems and strong data skills
Proficiency with data analysis tools, SQL, BI software (e.g., Tableau, Power BI), and statistical techniques
Presentation skills

Responsibilities

Management of Financial processes Manage time-sensitive monthly financial data processes, including inputting initial reserves and reserve changes as determined by Emory’s claims team, case settlements, legal and related vendor invoices, monthly accounting reconciliation and balancing, and fiscal year end closing Responsible for running and balancing the monthly loss runs with captive manager and actuary
Data Analysis & Reporting Collect, validate, normalize, and analyze medical professional and general liability claim data Develop, maintain, and run standard and ad hoc reports, including but not limited to monthly loss runs, transaction reports, and trend and severity analyses Track and keep current annual liability insurance tower erosion and limit exhaustion reports to track aggregate losses, paid/incurred amounts, and remaining limits across coverage layers Work with actuarial team to support actuarial analyses by preparing clean, accurate datasets for loss projections, reserve studies, and pricing evaluations Translate complex insurance and claims data into clear, actionable insights for leadership, risk management, legal, and finance stakeholders Respond to requests for specific data reports, such as claims data Medicaid and Medicare applications Develop dashboards and visual reports to track loss performance, emerging risks, and program effectiveness Identify opportunities to improve reporting efficiency, automation, and data accessibility A ssist in developing key performance indicators (KPIs) and metrics for insurance program Support internal and external audits by providing accurate, timely, and well-documented data Support system upgrades, data migrations, and enhancements related to reporting and analytics; for the claims management system, currently RLDatix
Reinsurance & External Carrier Reporting Work with VP, Insurance, captive manager, and insurance broker to track reinsured losses, recoverables, ceded premiums, and reinsurer participation by layer Support reconciliation of reinsurance payments and recoverables with finance and accounting teams Respond to reinsurer data requests, audits, and ad hoc reporting needs
Regulatory & Statutory Reporting Manage and support MMSEA (Medicare Secondary Payer) Section 111 reporting, including: Data extraction and validation Timely and accurate submissions to CMS Resolution of CMS errors, rejects, and compliance issues Support National Practitioner Data Bank (NPDB) reporting by ensuring data accuracy, completeness, and compliance with reporting thresholds and timelines