Manager, Claims Operations

Allied Benefit Systems•Chicago, IL

2d•$70,000 - $75,000•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 manager will identify strategic opportunities, provide support and leadership, and prepare reporting and analysis. They will also offer technical guidance to staff, partner with the analytical team, and review high-dollar cases. Collaboration with other Claims and business leaders is essential for driving enterprise initiatives. The role also includes creating a positive work environment, overseeing performance monitoring, and leading, coaching, and developing staff.

Requirements

Bachelor’s degree or equivalent work experience required.
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.
Reliable internet service is essential for staying connected and productive.
Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload.

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.