Manager, Claims Operations

Allied Benefit Systems•Chicago, IL

1d•$70,000 - $85,000•Remote

About The Position

The Manager, Claims Operations is responsible for managing the day-to-day operational functions of the Claims Appeals, Claims Medical Review, and Subrogation Teams. This role involves maintaining collective responsibility for the management of services provided by these teams, monitoring metrics and operations, and implementing best practices based on company goals. The position also requires identifying strategic opportunities through financial analysis, providing leadership and motivation, and preparing reports and analysis. Additionally, the Manager will offer technical guidance on claim investigation, reserving evaluation, and resolution, and partner with the analytical team for reporting. Key responsibilities include reviewing high dollar appeals, medical review referrals, and subrogation cases, managing daily claims production operations, and interacting extensively with parties involved in the claim process. The role demands staying current with claims management strategies, collaborating with other leaders on enterprise initiatives, and assisting with subrogation files. A crucial aspect is fostering an environment that encourages open communication and idea sharing, while overseeing performance monitoring against productivity and quality goals. The Manager will lead, coach, and develop staff through one-on-one meetings, performance appraisals, and talent attraction, ensuring clear communication of expectations and provision of necessary resources and training.

Requirements

At least 5 years of TPA or group health insurance experience including at least 3 years at a supervisor level and successfully demonstrated leadership competencies.
In-depth knowledge of Claims, Benefits and administrative skills and processes required.
Intermediate level work experience with Microsoft Office, Word, Excel, Access, and Power Point software applications.
The ability to easily learn other software and systems.
Must be able to write business correspondence and procedures.

Responsibilities

Maintains collective responsibility for the management of services provided by the Claims Appeals, Claims Medical Review and Subrogation Teams.
Responsible for monitoring metrics and operations within these teams.
Responsible for implementing best practices based on company goals.
Identify strategic opportunities based on financial analysis and projections, cost/benefit identification and analysis.
Provide support, guidance, leadership, and motivation to promote maximum performance.
Responsible for preparing reporting and analysis that is consistent with defined standards and processes.
Provide technical guidance to staff on claim investigation, reserving evaluation and resolution of claims.
Partner with analytical team to produce necessary results and trending reports for leadership.
Review high dollar appeals, medical review referrals, and subrogation cases from members, providers, and other entities.
Manage all aspects of the day-to-day operations of claims production.
Interact extensively with various parties involved in the claim process.
Remain current and aware of impact on claims management strategies.
Collaborate with other Claims and business leaders to define and drive enterprise initiatives.
Assist or prepare files for subrogation.
Create an environment that encourages and values the opinions of others and promotes sharing of information and ideas.
Oversee monitoring and tracking of individuals and the unit's performance against established productivity and quality goals and metrics.
Lead, coach, motivate and develop.
Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
Actively engage, coach, counsel and provide timely, and constructive performance feedback.
Other duties as assigned.