Claim Service Manager

A-G Specialty Insurance, LLC•Berwyn, PA

8h•Hybrid

About The Position

The Claim Service Manager is responsible for planning, organizing, directing, and overseeing a Claim Service Team that processes Accident & Health insurance claims. The role combines independent claim examination with the management and development of a team of direct reports. This role is open to fully remote or hybrid candidates.

Requirements

Team Player
Excellent verbal and written communication
Behavior flexibility, ability to adapt management style
Advanced critical thinking and problem-solving skills
Strong decision-making ability and sound judgement
Knowledge and understanding of Department of Insurance regulations
Exhibits leadership qualities and forward-thinking mindset
Ability to obtain and maintain Insurance Adjuster License
Bachelor’s Degree or comparable experience

Nice To Haves

3-5 years insurance experience
Accident & Health Adjuster License

Responsibilities

Interview, hire, train, and develop Claim Service Team
Ensure legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations and enforce equally and fairly on team
Analyze workload index and delegate responsibilities as needed
Review monthly claim audits along with performance management that includes goal setting, feedback, disciplinary action, and rewards
Developing performance metrics, goals, and best practices for both individuals and team
Establish and maintain constructive relationships with customers, clients, providers, and other key stakeholders
Monitor and provide feedback to Claim Management Leadership on the company’s proprietary claims system performance and areas of opportunity for system enhancements
Create a workplace culture that is consistent with the company’s mission, vision, and values
Assist in resolving complex claim and services issues
Demonstrate fundamentally sound claim handling by achieving compliance in the areas of investigation, coverage and processing of claims
Timely and appropriately communicate with the claimant and client, as well as internally
Establish proof of loss by reviewing medical documentation; assembling additional information as required from outside sources; including claimant, client, provider, and other insurance companies
Calculates and pays benefits due; approves and makes timely claim payments and adjustments
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
Recognize and properly address coverage issues, potential fraud, and subrogation
Ensure claim files are properly documented through internal notes and correspondence logs, and claim coding is correct
Refer cases as needed to Vice President of Claims, Insurance Carrier, Program Management, and other appropriate parties internally and externally.