[Hiring] Manager, Claims Operations @Allied Benefit Systems

Role Description

The Manager, Claims Operations is responsible for managing the day-to-day operational functions of the Claims Appeals, Claims Medical Review, and Subrogation Teams.

Essential Functions

• Maintains collective responsibility for the management of services provided by the Claims Appeals, Claims Medical Review and Subrogation Teams.
• Responsible for monitoring metrics and operations within these teams.
• Responsible for implementing best practices based on company goals.
• Identify strategic opportunities based on financial analysis and projections, cost/benefit identification and analysis.
• Provide support, guidance, leadership, and motivation to promote maximum performance.
• Responsible for preparing reporting and analysis that is consistent with defined standards and processes.
• Provide technical guidance to staff on claim investigation, reserving evaluation and resolution of claims.
• Partner with analytical team to produce necessary results and trending reports for leadership.
• Review high dollar appeals, medical review referrals, and subrogation cases from members, providers, and other entities.
• Manage all aspects of the day-to-day operations of claims production.
• Interact extensively with various parties involved in the claim process.
• Remain current and aware of impact on claims management strategies.
• Collaborate with other Claims and business leaders to define and drive enterprise initiatives.
• Assist or prepare files for subrogation.
• Create an environment that encourages and values the opinions of others and promotes sharing of information and ideas.
• Oversee monitoring and tracking of individuals and the unit's performance against established productivity and quality goals and metrics.
• Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
• Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
• Actively engage, coach, counsel and provide timely, and constructive performance feedback.
• Other duties as assigned.

Qualifications

• Bachelor’s degree or equivalent work experience required.
• At least 5 years of TPA or group health insurance experience including at least 3 years at a supervisor level and successfully demonstrated leadership competencies.
• In-depth knowledge of Claims, Benefits and administrative skills and processes required.
• Intermediate level work experience with Microsoft Office, Word, Excel, Access, and Power Point software applications.
• The ability to easily learn other software and systems.
• Must be able to write business correspondence and procedures.

Position Competencies

• Accountability
• Coaching and Feedback
• Collaboration
• Customer Focus
• Decision Making
• Execution Management
• People Leadership

Physical Demands

• This is a standard desk job requiring extended sitting and computer work.

Work Environment

• Remote

Benefits

• Competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance.
• Generous Paid Time Off.
• Tuition Reimbursement.
• EAP.
• Technology Stipend.