Claim Financial Process Manager

Emory Healthcare•Tucker, GA

2d•Hybrid

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) Processes and monitors claim related payments and assures monthly reconciliation for EHC, CCIC, and its actuary Manages the monthly indemnity and legal expense payment process for Medical Professional, General Liability and Network Security & Privacy matters payable under the Emory Liability Insurance Program through CCIC Tracks and creates monthly loss runs which tracks all payment and reserve related movement for third party liability matters insured under CCIC This role also has claims data analytics components, responsibility for analyzing insurance claims data for reporting purposes, to find trends, and support decisions The Claim Financial 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 Management of Financial processes for CCIC: Manages time-sensitive monthly financial data processes, including inputting initial reserves and reserve changes, 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 for CCIC 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 Update tower erosion and 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 Use data to support strategic risk mitigation initiatives and loss prevention efforts Assist in developing key performance indicators (KPIs) and metrics for captive operations 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: a. Data extraction and validation b. Timely and accurate submissions to CMS c. 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 Additional Duties as Assigned

Requirements

Bachelor's degree in a business-related field
Minimum five years relevant experience
Knowledge 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

Processes and monitors claim related payments and assures monthly reconciliation for EHC, CCIC, and its actuary
Manages the monthly indemnity and legal expense payment process for Medical Professional, General Liability and Network Security & Privacy matters payable under the Emory Liability Insurance Program through CCIC
Tracks and creates monthly loss runs which tracks all payment and reserve related movement for third party liability matters insured under CCIC
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
Update tower erosion and 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
Use data to support strategic risk mitigation initiatives and loss prevention efforts
Assist in developing key performance indicators (KPIs) and metrics for captive operations
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
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
Manage and support MMSEA (Medicare Secondary Payer) Section 111 reporting
Support National Practitioner Data Bank (NPDB) reporting by ensuring data accuracy, completeness, and compliance with reporting thresholds and timelines
Additional Duties as Assigned