Oversees the handling of all aspects of the claims assigned to the team including reserving, communication, documentation, evaluation, negotiation, and settlement. Ensures all claims eligible or ineligible for payment conform to quality and production standards and specifications. Ensures claim processing is consistent with applicable policies, procedures, and department guidelines. Reviews and addresses complaints that claims specialists are unable to resolve and prepares formal responses to consumer complaints. Analyzes and approves insurance claim payments. Provides file authority as appropriate to unit staff. Establishes and executes controls to assure that the quality of the work meets or exceeds standards. Completes regular quality audits of staffs work, records, and results; mentors or counsels staff to bring work at or above standards. Prepares regular periodic reports and monitors system reports to ensure adherence to corporate and regulatory standards. Assures that all customers receive exceptional service. Analyzes, adjusts, and approves or denies outside vendor bills. Reviews and analyzes processes, procedures, and workflows to identify opportunities for process improvement and efficiency. Participates in the specialized training and handling of complex claim matters and special projects requiring advanced claim knowledge and experience. May recruit, hire, recommend or initiate promotions and transfers and makes salary recommendations. Completes performance evaluations and makes merit increase recommendations; issues performance improvement plans and corrective action when needed. Manages the development and training of subordinates, including monitoring and relaying information to the staff regarding changes in coverage and laws. Performs other related duties as assigned.
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Job Type
Full-time
Career Level
Manager
Education Level
High school or GED