Claims Manager

Tristar Insurance • Lakewood, CO

3d • $95,000 - $105,000 • Hybrid

About The Position

Under minimal supervision, manages and directs the activity of the claims unit, ensuring high-quality results and management of claims in compliance with state laws and company procedures.

Requirements

• High School Diploma or GED required.
• Bachelor’s degree in related field (preferred); five (5) to ten (10) years related experience; or equivalent combination of education and experience.
• Technical knowledge of statutory regulations and medical terminology.
• Ability to work on a diary system, prioritize tasks, and meet strict deadlines.
• Strong analytical skills.
• Proficient in Word and Excel.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to manage employees of various skill levels.
• Excellent interpersonal skills.
• Excellent customer service skills.

Responsibilities

• Directly supervises examiners and clerical staff. Includes monitoring attendance, job performance, evaluations, and disciplinary issues.
• Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.
• Reviews and approves reserve changes, awards, and payments.
• Performs file reviews to monitor compliance with policies and laws.
• Coordinates and leads training sessions for staff on updated laws, policies, and procedures.
• Conducts and documents in-house and outside educational sessions.
• Ensures daily caseload staffing requirements are met.
• Supervises and approves check runs and registers daily.
• Respond to claimant and vendor concerns and issues as needed.
• Monitors the effectiveness of vendors.
• Ensures client servicing instructions are being adhered to.
• Provides coverage for examiner vacancies due to vacation or vacancies.
• Prepares and evaluates monthly client reports.
• Facilitates internal and external audits.
• Partners with corporate office and sales/service team for RFP’s and service issues.
• Attends client file reviews.
• Provides account management to those accounts without an assigned account manager.
• Monitors branch expenses and approves invoices, etc.
• Other duties as assigned. Essential job function.

Benefits

• Medical, Dental, Vision Insurance.
• Life and Disability Insurance.
• 401(k) Plan
• Paid Holidays
• Paid Time Off.
• Referral bonus.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 251-500 employees