About this role
Role Overview
- To supervise the operation of multiple teams of examiners and technical staff for liability claims for clients;
- To monitor colleagues' workloads, provide training, and monitor individual claim activities;
- To provide technical/jurisdictional direction to examiner reports on claims adjudication;
- To maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.
- Identifies and advises management of trends, problems, and issues as well as recommended course of action.
- Provides technical/jurisdictional direction to examiner reports on claims adjudication.
- Compiles reviews and analyzes management reports and takes appropriate action.
- Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
- Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
- Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
- Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
- Maintains contact with the client on claims and promotes a professional client relationship;
- Assures that direct reports are properly licensed in the jurisdictions serviced.
- Ensures claims files are coded correctly and adequate documentation is made by claims examiners.
Requirements
- High School Diploma or GED required.
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.