Manager Long Term Care Claims

Northwestern Mutual

About The Position

Primary Duties and Responsibilities Directs and manages the operations of the LTC Benefits Division through the recruitment, selection, training, development, retention, motivation and salary administration of the LTC Benefits service support personnel, analysts, and specialists. Manages and oversees select LTC Benefits service support personnel, analysts, and specialists to ensure accurate and timely claim decisions and payment processing. Ensures adherence to established practices and procedures, and to our claim philosophy through claim monitoring and quality assurance reviews, in collaboration with the Assistant Director, other Division Managers, and the Team Consultants. Creates, monitors and maintains productivity and quality standards. Participates/manages projects and/or workflow design efforts as required. Directs and monitors the activities of the LTC Benefits service support personnel, analysts, and specialists to ensure optimum efficiency, effectiveness and quality by formulating and overseeing business unit goals, budgets, operating policies and procedures. Responsible for integrating triaging/restaging efforts within the Division through proactive recommendations and implementation of employee skills, processes, and organization structure (roles, responsibilities and job design). Includes introduction of workforce management principles as appropriate, and implementation of change management programs. Managerial Accountabilities: In conjunction with other LTC Benefits Managers will ensure appropriate evaluation, accurate payment and professional service in handling LTC insurance claims in accordance with the relevant contracts and NM claim philosophy. Ensure achievement of service, production, and performance goals. Along with other LTC Benefits Managers supervises the day-to-day operations of the LTC Benefits Divisions to include workflow, selection, motivation, development and guidance of staff including salary and promotion recommendations, job performance and training. Participates in the management of divisional budget. Directs and coordinates the work activities of a high level of professional/technical staff ranging from senior to management at the high specialist level. Performs all aspects of performance management and career development including compliance with NM's Affirmative Action programs and EEO law and regulations. Performs full range of human resources responsibilities including communication; coaching and staff development; performance management; staffing; and salary administration, while adhering to the company's human resources policies and procedures. Works to ensure that appropriate practices and procedures are adhered to in the processing of LTC benefit payments. Assures the LTC Benefits Division effectively interprets contract provisions, adheres to state regulations, and analyzes facts to reach claim decisions on new and continuing claims, consistent with NLTC's claim philosophy in collaboration with the Assistant Director and the Team Consultants. Works to maintain NLTC's image and reputation in the customer servicing and processing benefit requests, particularly in the fact of difficult and delicate circumstances. Keeps work within team goals using the LTC Service Goals and provides support where necessary to adhere to these goals. As part of the claim handling process, may be called upon to represent the company in legal matters through preparation for and participation in depositions and trials. Coordinates and leads complex system and process improvement initiatives in divisional or departmental projects the LTC Department. Provides leadership to all aspects of these systems and process improvements including workflow, process changes, and system development initiatives. Acts as liaison to other insurance operations departments when implementing initiatives. Responds to complex/sensitive customer service complaints and questions in compliance with the National Association of Insurance Commission guidelines

Requirements

A minimum of three years of management experience.
A bachelor's degree and demonstrated knowledge in insurance department policies, procedures and systems required.
Must have a strong interest in people development.
Superior written and training presentation skills.
Superior analytical skills and proven ability to exercise sound judgment and decision-making skills.
Excellent communication, interpersonal, planning and organization skills.
High degree of independent initiative and organization, along with demonstrated ability to effectively manage multiple assignments concurrently, set priorities and meet aggressive deadlines.
Demonstrated ability to facilitate and work effectively with people at all levels within and outside the department; demonstrated diplomacy, sensitivity and flexibility in adapting to rapidly changing needs and priorities.
Effectively able to listen to, engage, negotiate and influence clients; synthesize and relate complex information; analyze communication and execution problems and opportunities; and develop and implement integrated training / educational strategies.
Experience negotiating problem resolutions with the field and Policyowners with proven ability to exercise tact, diplomacy, resourcefulness and understanding to gain trust and customer confidence.
Experience in leading change management initiatives and/or process improvements.

Nice To Haves

Experience in training development and/or training experience demonstrating a proven track record in researching, designing, developing and implementing complex training programs preferred.

Responsibilities

Directs and manages the operations of the LTC Benefits Division through the recruitment, selection, training, development, retention, motivation and salary administration of the LTC Benefits service support personnel, analysts, and specialists.
Manages and oversees select LTC Benefits service support personnel, analysts, and specialists to ensure accurate and timely claim decisions and payment processing.
Ensures adherence to established practices and procedures, and to our claim philosophy through claim monitoring and quality assurance reviews, in collaboration with the Assistant Director, other Division Managers, and the Team Consultants.
Creates, monitors and maintains productivity and quality standards.
Participates/manages projects and/or workflow design efforts as required.
Directs and monitors the activities of the LTC Benefits service support personnel, analysts, and specialists to ensure optimum efficiency, effectiveness and quality by formulating and overseeing business unit goals, budgets, operating policies and procedures.
Responsible for integrating triaging/restaging efforts within the Division through proactive recommendations and implementation of employee skills, processes, and organization structure (roles, responsibilities and job design).
Includes introduction of workforce management principles as appropriate, and implementation of change management programs.
Ensure appropriate evaluation, accurate payment and professional service in handling LTC insurance claims in accordance with the relevant contracts and NM claim philosophy.
Ensure achievement of service, production, and performance goals.
Supervises the day-to-day operations of the LTC Benefits Divisions to include workflow, selection, motivation, development and guidance of staff including salary and promotion recommendations, job performance and training.
Participates in the management of divisional budget.
Directs and coordinates the work activities of a high level of professional/technical staff ranging from senior to management at the high specialist level.
Performs all aspects of performance management and career development including compliance with NM's Affirmative Action programs and EEO law and regulations.
Performs full range of human resources responsibilities including communication; coaching and staff development; performance management; staffing; and salary administration, while adhering to the company's human resources policies and procedures.
Works to ensure that appropriate practices and procedures are adhered to in the processing of LTC benefit payments.
Assures the LTC Benefits Division effectively interprets contract provisions, adheres to state regulations, and analyzes facts to reach claim decisions on new and continuing claims, consistent with NLTC's claim philosophy in collaboration with the Assistant Director and the Team Consultants.
Works to maintain NLTC's image and reputation in the customer servicing and processing benefit requests, particularly in the fact of difficult and delicate circumstances.
Keeps work within team goals using the LTC Service Goals and provides support where necessary to adhere to these goals.
As part of the claim handling process, may be called upon to represent the company in legal matters through preparation for and participation in depositions and trials.
Coordinates and leads complex system and process improvement initiatives in divisional or departmental projects the LTC Department.
Provides leadership to all aspects of these systems and process improvements including workflow, process changes, and system development initiatives.
Acts as liaison to other insurance operations departments when implementing initiatives.
Responds to complex/sensitive customer service complaints and questions in compliance with the National Association of Insurance Commission guidelines