CLAIMS REVIEW SUPERVISOR/EXPERT

State of Arkansas•Harrison, AR

1d•Onsite

About The Position

Claims Review Supervisor/Expert position is responsible for supervising the Program Eligibility Specialists in the UI Benefits Hotline to guarantee adequate coverage on the Hotline at all times. In addition, the Claims Review Supervisor/Expert will review calls taken by their staff to check for accuracy and customer service expectations. This requires a high level of accountability in ensuring the work their staff is doing is in compliance with state and federal regulations and agency policies. Success in this position depends on strong communication skills to effectively engage with their staff with a focus on efficiency in protecting the integrity of the trust fund. This position requires extensive UI knowledge. This staff may also have to communicate with other UI units as well as employers, Legislative staff, and staff from the Governor's office. This position requires on-site employment with no remote or hybrid options available. Job Summary 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.Primary ResponsibilitiesThe assignment of supervisory duties is determined by the hiring agency's operational needs. Non-supervisory roles will serve as senior technical experts.

Requirements

Knowledge of computers, office equipment, and imaging programs
Ability to develop, recommend, interpret, and apply policies and procedures.
Must have good customer service skills - verbal and written.
Good communication skills.
Good research skills.
Good critical thinking skills.
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.

Nice To Haves

One (1) year experience working with the Unemployment Insurance program and intensive knowledge of UI system and program processes and terminology. Previous experience in supervising staff. Additionally, experience conducting business via telephone and/or email is a must.

Responsibilities

Provide support and supervision of UI Benefits Hotline Program Eligibility Specialists one-on-one or through the UI Benefits Hotline Teams Chat.
Monitor UI Benefits Hotline to ensure adequate coverage of the hotline.
Review UI Benefits Hotline statistics daily to discover calls lasting over 20 minutes, long hold times, or any anomaly in the hotline calls to determine if there is any training or procedure changes required.
Provide any specific UI Benefits Hotline analytics listed in the hotline statistics reports to the Commerce Program Supervisor/Expert or UI Administration per request.
Answer questions from Program Eligibility Specialists, claimants, or employers regarding UI. This requires a basic knowledge of UI processes and procedures and a level of critical thinking to apply state or federal law.
Responds to inquiries and processes requests from other ADWS UI units including UI Intake and Support, UI Claims Processing, UI Correspondence, Automated Adjudication Systems (AAS), Benefit Accuracy Measurement (BAM), Contributions, and other units regarding individual claims or issues found.
Listen to Program Eligibility Specialists calls for quality purposes.
Research claims to detect problems and provide feedback on issues detected.
Performs other duties as defined and assigned by UI Administration.
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.