To supervise, monitor and evaluate the needs and objectives of claims department in order to ascertain that company directives and goals are being met.
Essential Functions & Responsibilities
- Supervise, monitor and coach the claims management team and their staff in their daily responsibilities.
- Answers and resolves claims operational problems and issues that arise during the companies daily activities.
- Maintain working knowledge of all systems used in the adjudication of claims.
- Monitor the Productivity and Quality of assigned Departments to ensure that company standards are being met.
- Maintain turn around times of assigned departments at the expected company and industry standards.
- Report to VP of Claims Operations any problem areas requiring further attention.
- Participate and conduct with the VP of Claims Operations weekly staff meetings with the claims management staff to provide ongoing feedback of overall departmental performance.
- Maintain reporting of department receipts, productivity, quality and analysis of overall departments’ performance.
- Prepare analysis reports that identify any potential operational issues that require follow up to ensure compliance within the company.
- Review system limitations and department limitations and propose alternative methods of resolution to the VP of Claims Operations.
- Review system enhancements for the claims adjudication systems.
- Prepare and maintain department processing guidelines, policies and procedures.
- Completes annual reviews of direct reports and reviews the claims op staff reviews with respective managers.
- Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
- Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
- Ability to come to work and work the regular schedule and shift for the position.
- Compliance with all personnel policies and procedures.
- Special projects and other duties as assigned by senior management.
- Perform additional duties and related essential duties as assigned.