Summary

Manages commercial and government claims processing, adjustments and support unit functions for assigned clients ensuring that all contractual obligations and service levels are met.

Primary Duties and Responsibilities

Primary duties and responsibilities include:

• Carries out supervisory responsibilities in accordance with policies and laws. May require interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance via the KPMS; rewarding and disciplining employees; addressing complaints and resolving problems.
• Develops and administers a business plan, controls expenses, and increases profitability to meet established business goals; manages budget while meeting operational, financial and service requirements.
• Measures and reports on service operations performance including, but not limited to claims accuracy rates (statistical and monetary), claims cycle performance, high dollar claims and late fees, performance of appropriate delegated vendors and partners, and inquiries and complaints.
• Implements and maintains policies and procedures on the claim functions that are appropriate to the management of the business client.
• Participates in responding to Requests for Proposals or Information (RFP and RFI) and serves as the liaison for claims operations for onsite visits by prospective and existing clients.
  

Managerial Responsibilities

The position will be typically responsible for managing the following positions

• Team Lead, Claims
• Team Lead, Adjustments
• Various levels of Claims Examiner titles

Education and Certifications

• Requires High School degree or GED. AA Or BS Preferred.