Mgr, Claims Operations

• Acting as a Champion for Change

• Acting with Integrity

• Communicating Effectively

• Demonstrating Initiative

• Developing Talent

• Managing Performance

• Pursuing Self-Development

• Serving Customers

• Supporting Change

• Supporting Organizational Goals

• Working with Diverse Populations

What does it take to be successful in this role?

• Broad knowledge of production management concepts, operating principles, and operational management methodology applicable to claims processing; a high degree of skill in applying this knowledge to the analysis and resolution of very complex or sensitive claims operational issues; ability to apply new developments and methodologies to direct the improvement in efficiencies

• Broad knowledge of federal, state, and local regulatory and industry requirements, standard concepts, practices, and procedures as they relate to the insurance industry and claims processing

• Knowledge of budgeting and expense control to plan, implement, and maximize expenditure of funds while maintaining and improving quality standards

• Knowledge of employee relations to conduct and deal with employee issues in a proactive manner

• Strong personal computer skills with experience in Windows-based software; experience using Microsoft Outlook or a similar e-mail system software

• Excellent presentation, oral, written, and interpersonal communications skills to effectively interact with senior management, and internal and external business contacts

• Bachelor's Degree In Health Administration, Business, or a related field.

• 6 years of job-related work experience.

• Job related expereince for this role is claims managment in LOA, FMLA, State Statutory Leave.

• 4 years in a leadership/senior/supervisory capacity.

• Claims administration, or experience in a related field or industry.

• Insurance or other industry designations

Principal Duties & Responsibilities

• Manages the daily operations of the Claims business unit; manages employees and operations of the business unit at the functional level; gathers and analyzes data and reports that pertain to the overall operation of the Claims business unit and completes reports summarizing activities and trends; assists in strategic and tactical operational plans to ensure achievement of company and departmental goals; performs independent review of problem situations; develops solutions and implements actions to resolve problems and ensure customer satisfaction; reviews processes and procedures to streamline activities to enhance service turnaround time, productivity, and quality; coordinates overall workflow of the business unit and ensures that workflow processes facilitate effective and efficient use of corporate resources and enhance customer satisfaction

• Directs efforts to implement risk management and quality improvement initiatives; facilitates calibration sessions; uses methods such as work process studies, statistical analysis, and assessments of production area performance to establish adherence to quality standards/scorecards; remains abreast of industry trends and technology changes; incorporates best practices in the development of quality standards, policies, programs, and system changes for the department; ensures that claims are processed according to appropriate risk selection principles

• Coordinates and monitors training efforts to ens