CLAIMS REVIEW SUPERVISOR/EXPERT

State of Arkansas • Little Rock, AR

5d • $52,137 - $77,163

About The Position

The Claims Review Supervisor / Expert is a senior-level professional responsible for overseeing the evaluation and processing of complex insurance claims. Leveraging their in-depth knowledge and extensive experience, they ensure claims are handled with accuracy, efficiency, and in compliance with pre-determined agency policies and legal regulations. This role requires advanced analytical capabilities to assess high-value or intricate claims, mentor junior team members, and drive strategic improvements in claims management processes. The Claims Review Supervisor / Expert is pivotal in maintaining organizational integrity, reducing risk, and enhancing customer trust.

Requirements

• Advanced analytical skills and attention to detail.
• Strong leadership and mentoring abilities.
• Proficient in claims management systems and tools.
• Excellent written and verbal communication skills.
• Sound knowledge of relevant legal and regulatory frameworks.
• Bachelor’s degree in a relevant field, such as business administration, finance, insurance, risk management, or healthcare administration.
• Minimum of 4 years of experience in claims review, analysis, or a related field within the insurance or financial services industry.
• Demonstrated expertise in handling complex claims and a proven track record of high-level decision-making.
• Experience in a specialized claims sector, such as healthcare, property and casualty, or workers’ compensation may be required.
• Professional certifications such as Associate in Claims (AIC), Certified Professional Claims Analyst (CPCA), or Chartered Property Casualty Underwriter (CPCU) may be required.

Responsibilities

• Conduct comprehensive reviews of complex, high-value, or specialized claims to determine eligibility and validity.
• Provide guidance and resolution for escalated claims that require expert analysis and decision-making.
• Collaborate with internal personnel, external personnel, and legal teams in an attempt to resolve disputes and ensure compliance with regulations.
• Design and implement process improvements in an attempt to optimize claims handling efficiency and accuracy.
• Lead or contribute to fraud detection initiatives by identifying patterns and assessing claims for potential fraudulent activity.
• Serve as a subject matter expert and mentor for junior claims analysts, providing training, support, and development opportunities.
• Stay abreast of industry trends, regulatory changes, and best practices to ensure claims processes align with current standards.
• Generate detailed reports and present data-driven insights to senior management to guide policy adjustments or operational decisions.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior