Mgr, Claims Operations
About The Position
The Manager of Claims Operations manages daily operations, employees, and functional activities of the Claims business unit. The role analyzes operational data and trends, supports strategic and tactical plans, resolves complex or sensitive operational problems, and improves workflow, service turnaround time, productivity, quality, and customer satisfaction. It directs risk management and quality improvement initiatives, establishes and maintains quality standards, and ensures claims are processed according to appropriate risk selection principles. The position coordinates employee training and development, projects staffing needs, and guides supervisors in coaching and counseling employees. It assesses business technology needs, recommends solutions and enhancements, leads assigned initiatives, and supports companywide projects. The manager also monitors operating expenses, contributes to the annual business unit budget, and reviews legal files while coordinating with counsel in preparation for depositions and court hearings. This is a remote role based from the employee’s home within the continental United States. Employees may occasionally be asked to come to an office based on business needs, with advance notice.
Requirements
- Bachelor’s degree in Health Administration, Business, or a related field, or an equivalent combination of education and experience.
- Six years of job-related work experience.
- Four years in a leadership, senior, or supervisory capacity.
- Broad knowledge of production management concepts, operating principles, and operational management methodologies applicable to claims processing.
- Ability to apply claims operations knowledge to analyze and resolve complex or sensitive issues and improve operational efficiency.
- Broad knowledge of federal, state, and local regulatory and industry requirements, concepts, practices, and procedures related to insurance and claims processing.
- Knowledge of budgeting and expense control to plan and manage expenditures while maintaining and improving quality standards.
- Knowledge of employee relations and ability to address employee issues proactively.
- Strong personal computer skills and experience with Windows-based software.
- Experience using Microsoft Outlook or similar email software.
- Excellent presentation, oral, written, and interpersonal communication skills to interact effectively with senior management and internal and external business contacts.
Nice To Haves
- Claims administration experience or experience in a related field or industry.
- Insurance or other industry designations.
Responsibilities
- Manage daily operations, employees, and functional activities of the Claims business unit.
- Gather and analyze operational data and reports, and prepare reports summarizing activities and trends.
- Assist with strategic and tactical operational plans to achieve company and departmental goals.
- Independently review problem situations, develop solutions, and implement actions to resolve problems and support customer satisfaction.
- Review processes and procedures to improve service turnaround time, productivity, quality, and efficient use of corporate resources.
- Coordinate business unit workflow to support effective operations and customer satisfaction.
- Direct risk management and quality improvement initiatives and facilitate calibration sessions.
- Use work process studies, statistical analysis, and production-area assessments to establish adherence to quality standards and scorecards.
- Monitor industry trends and technology changes, and incorporate best practices into departmental quality standards, policies, programs, and system changes.
- Ensure claims are processed according to appropriate risk selection principles.
- Coordinate and monitor employee training; identify and communicate training needs and schedules with the training department.
- Project staffing requirements and guide supervisors in coaching and counseling employees.
- Coordinate employee development and incentive initiatives.
- Identify, analyze, and monitor business technology requirements and enhancement opportunities; recommend viable solutions, modifications, and applications.
- Prepare recommendations for initiatives, lead assigned initiatives, and participate in companywide projects such as Quality Circles and Focus Groups.
- Monitor and control operating expenses and provide input into the annual business unit budget.
- Review legal files and coordinate with counsel to prepare for depositions and court hearings.
- Perform other related duties as required.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Prescription drug coverage
- Health care flexible spending account
- Dependent care flexible spending account
- Aflac supplemental Accident, Cancer, Critical Illness, and Hospital Indemnity policies offered at no cost to employees
- 401(k) plans
- Annual bonuses
- Opportunity to purchase company stock
- 11 paid holidays annually
- Up to 20 days of PTO for any reason
- State-mandated sick leave, if eligible
- Other leaves of absence, if eligible, including adoption and parental leave as applicable
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What This Job Offers
Job Type
Full-time
Career Level
Manager
