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Mgr, PLADS Claims Operations
Location: Remote, US, 31999
Job Summary
Manager of a front line claims operational team is responsible for the direct supervision of Case Managers, operational results, and performance of those Case Managers. Also involved in direct customer and sales interaction as it relates to our process and case management.
Principal Duties & Responsibilities
Oversees daily operations of multiple levels of staff and multiple functions across one or more business units
Manages day to day site operations and accountability for financial and non-financial results (budgets and actuals)
Provides expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjusting claims
Attends/participates in select customer meetings as appropriate to discuss feedback and/or needed process enhancements
Initiates and maintains partnerships with others throughout the organization
Encourages cooperation by promoting common goals and building trust
Inspires, supports, and initiates cross-functional activities
Authorizes the appropriate payment or refers claims to investigators for further review
Analyzes and identifies trends and provides reports as necessary
Leads project management and implementation initiatives
Supports employee development by conducting regularly scheduled 1x1s with direct reports
Provides appropriate oversight to ensure team successfully achieves targets to meet performance guarantees
Performs other related duties as required
Education & Experience Required
- Bachelor’s Degree in related field
- 5+ years of claims industry experience
- 5+ years of Supervisory, Managerial, and / or leadership experience in claims
adjudication or customer service
- 2+ years of experience managing relationships with clients and / or vendors
- 2+ years of experience managing budgets, process improvement and quality assurance
- Proficiency within Microsoft Excel (ability to create pivot tables, basic formulas, sorting, and read data)
Or an equivalent combination of education and experience
Education & Experience Preferred
- Operation Excellence (Six Sigma) experience
Job Knowledge & Skills
Ability to be proactive
Sense of Urgency
Time Management Skills
Ability to follow through with daily tasks
Competencies
- Acting with Integrity
- Communicating Effectively
- Pursuing Self-Development
- Serving Customers
- Supporting Change
- Supporting Organizational Goals
- Working with Diverse Populations
Leader Competencies
- Acting as a Champion for Change
- Demonstrating Initiative
- Developing Talent
- Managing Performance