Team Leader, LTD Claims Case Management

Guardian Life Insurance

10d•Remote

About The Position

As the Team Leader, LTD Claims Case Management, you will be responsible for validating that all LTD claims are accurately and fairly adjudicated according to plan provisions, established best practices and within state and federal guidelines. As the Team Leader you must be able to manage and resolve issues that pertain to claim administration procedures cost containment activities, reports and quality control issues. You will serve as primary resource for the team and provide direction to the staff members by setting objectives, communicating progress and goals, and holding the staff accountable for adhering to all quality assurance, turnaround times, best practice standards, and operational efficiency. You are also responsible for assisting staff with career development and career progression. The Team Leader partners with internal cross functional areas for program direction, goal setting, service delivery and development of action plans and leveraging bench strength. You will also work with external customers to enhance the overall experience for the customer. The Team Leader is responsible for the overall functioning of the department. You are A true leader who fosters a culture where diverse thoughts, experiences, and backgrounds are valued and celebrated Empowering to employees to take the initiative to further team and company goals and encourage candor and transparency able to create a safe environment to try new ideas and make mistakes and able to demonstrate the courage to make difficult decisions and have candid conversations Able to demonstrate a high performance standard for employees and team Balances risk with growth opportunities Able to maintain a strong external focus, voice of customer, industry and regulatory Strategically aligned to processes and resources for future goals and objectives You will Manage People 40% Develop employee goals to promote career growth that enhance level of knowledge for future opportunities Cross collaboration with business partners including Life and Disability, CRU, SIU, Sales Force, Group Quality Management and other areas within the company Promote leadership model to support Guardian values Develop and communicate objectives and performance goals for the department Managing direct report’s performance by coordinating with HR business partners to develop coaching plans and performance improvement plans Create yearly action plan based on the results from the employee engagement survey Manage Risk 30% Based on feedback from technical consultant review daily, weekly and monthly reports on team productivity 1) for operational reporting and monitoring purposes; and 2) to identify trends and training opportunities Coordinate and monitor overpayment recovery efforts, vendor/legal negotiations and tracking for liability and reporting purposes Monitor claim turnaround times to validate decisions are made within DOL and policy time frames Oversee settlement checks in accordance with settlement agreements Assist in self-testing for MARs Financial Control Train and Develop 20% Develop training tools in conjunction with technical experts to deliver training to the staff Empower staff through brainstorming sessions to revise workflows and procedures that promote best practices Support strategic initiatives from a Life/DI claim perspective with contract rewrites and related projects Prepare agenda, schedule and facilitate team meetings Mentor, coach, supervise and develop talent of direct reports by recommending and coordinating training plans for individuals to exceed personal and departmental goals and objectives Review claim staff QA assessments for training or enhancement opportunities Manage Processes 10% Identify Continuous Improvement opportunities by reviewing process and eliminating unnecessary steps Validate refund and returned checks are processed in an accurate and timely manner and in accordance to departmental policy Assist manager with departmental budget and vendor expenses Identify claim success stories that promote Guardian’s value proposition

Requirements

Minimum of 5 years of LTD claims experience
Bachelor’s Degree in related field and/or equivalent relevant disability work experience
Previous leadership experience in decision making, trouble shooting, staff development, and related skills and abilities
Excellent organizational and time management skills
Excellent math aptitude and analytical skills
Professional oral, written and presentation skills
Strong PC skills, including Microsoft Office applications
Extensive knowledge of Guardian’s disability products, business rules and procedures
Familiarity with mandated state and federal regulations

Nice To Haves

DCMS claim system knowledge a plus

Responsibilities

Validating that all LTD claims are accurately and fairly adjudicated according to plan provisions, established best practices and within state and federal guidelines
Manage and resolve issues that pertain to claim administration procedures cost containment activities, reports and quality control issues
Serve as primary resource for the team and provide direction to the staff members by setting objectives, communicating progress and goals, and holding the staff accountable for adhering to all quality assurance, turnaround times, best practice standards, and operational efficiency
Assisting staff with career development and career progression
Partnering with internal cross functional areas for program direction, goal setting, service delivery and development of action plans and leveraging bench strength
Working with external customers to enhance the overall experience for the customer
Overall functioning of the department
Develop employee goals to promote career growth that enhance level of knowledge for future opportunities
Cross collaboration with business partners including Life and Disability, CRU, SIU, Sales Force, Group Quality Management and other areas within the company
Promote leadership model to support Guardian values
Develop and communicate objectives and performance goals for the department
Managing direct report’s performance by coordinating with HR business partners to develop coaching plans and performance improvement plans
Create yearly action plan based on the results from the employee engagement survey
Based on feedback from technical consultant review daily, weekly and monthly reports on team productivity 1) for operational reporting and monitoring purposes; and 2) to identify trends and training opportunities
Coordinate and monitor overpayment recovery efforts, vendor/legal negotiations and tracking for liability and reporting purposes
Monitor claim turnaround times to validate decisions are made within DOL and policy time frames
Oversee settlement checks in accordance with settlement agreements
Assist in self-testing for MARs Financial Control
Develop training tools in conjunction with technical experts to deliver training to the staff
Empower staff through brainstorming sessions to revise workflows and procedures that promote best practices
Support strategic initiatives from a Life/DI claim perspective with contract rewrites and related projects
Prepare agenda, schedule and facilitate team meetings
Mentor, coach, supervise and develop talent of direct reports by recommending and coordinating training plans for individuals to exceed personal and departmental goals and objectives
Review claim staff QA assessments for training or enhancement opportunities
Identify Continuous Improvement opportunities by reviewing process and eliminating unnecessary steps
Validate refund and returned checks are processed in an accurate and timely manner and in accordance to departmental policy
Assist manager with departmental budget and vendor expenses
Identify claim success stories that promote Guardian’s value proposition