Senior Claims Manager

Trustmark

8d • $71,520 - $103,308

About The Position

Responsible for overseeing a claims processing organization. Ensures claims are processed in a timely manner in accordance and compliant with government regulations. Develops claims adjudication policies and procedures that maximize the accuracy of claims payments. Evaluates claims activities to assess cost-effectiveness and implement process improvement initiatives.
Manages the overall operations of the department, including individual contributors and supervisors, ensuring compliance with company policies, industry regulations, and service level agreements. Serves as lead for claim processes, regulations and industry standard projects.
Analyzes workflow and determine actions needed to meet current and future production/ staffing needs. Works with cross-functional teams and serving as claims subject matter expert. Identifies trends, develops, and implements plans to improve results and processes.
Researches, investigates and responds to escalated service issues with internal and external customers. Takes necessary corrective action including root cause analysis when appropriate. Provides sign-off approval of complex or high-dollar claims.
Supports training and implementation of new processes and systems required to manage administration of policy changes.
Participates in or leads multiple projects by assigning resources, working on timelines and implementing schedule to complete project timeline.

Requirements

• Bachelor's Degree with 4-6 years of related experience OR High School Diploma or GED with 6-8 years related experience.

Responsibilities

• Oversee a claims processing organization.
• Ensure claims are processed in a timely manner in accordance and compliant with government regulations.
• Develop claims adjudication policies and procedures that maximize the accuracy of claims payments.
• Evaluate claims activities to assess cost-effectiveness and implement process improvement initiatives.
• Manage the overall operations of the department, including individual contributors and supervisors, ensuring compliance with company policies, industry regulations, and service level agreements.
• Serve as lead for claim processes, regulations and industry standard projects.
• Analyze workflow and determine actions needed to meet current and future production/ staffing needs.
• Work with cross-functional teams and serve as claims subject matter expert.
• Identify trends, develop, and implement plans to improve results and processes.
• Research, investigate and respond to escalated service issues with internal and external customers.
• Take necessary corrective action including root cause analysis when appropriate.
• Provide sign-off approval of complex or high-dollar claims.
• Support training and implementation of new processes and systems required to manage administration of policy changes.
• Participate in or lead multiple projects by assigning resources, working on timelines and implementing schedule to complete project timeline.

Benefits

• Health/dental/vision
• life insurance
• FSA and HSA
• 401(k) plan
• Employee Assistant Program
• Back-up Care for Children, Adults and Elders
• health and wellness initiatives
• Wellness program that enables employees to participate in health initiatives to reduce their insurance premiums.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree