We are looking for someone to lead, direct and manage the Long Term Care (LTC) Claim Department – including supervisors and staff. You will be responsible for the overall planning and implementation of claims, improving efficiency and implementing productivity improvements resulting in a client focused service delivery. You will also monitor and control costs while maintaining exceptional service levels, and determine strategies that will increase the company’s profitability. As the leader within the claim department, you will have to establish specific performance expectations, service delivery requirements and audit programs to ensure adherence to policy and procedures and assist in designing and implementing goal oriented training programs for new and existing team members.
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Essential Duties and Responsibilities include the following (Other duties may be assigned)
Provide leadership and guidance to Supervisors to develop highly skilled, result oriented and customer focused teams that consistently meet and/or exceed service levels and performance standards.
Establish clear and concise performance standards and service levels and implement processes that monitor gap analysis and incorporate corrective action planning.
Oversee the set up and delivery of strategic training programs for inexperienced and experienced claim advisors and encourage external training.
Develop, recommend and implement strategic programs and procedures that encourage customer loyalty, company profitability and cost effective productivity.
Ensure that Claims is adequately staffed and team members are provided with the appropriate resources to provide exceptional client service.
Direct all aspects of recruitment and develop interview techniques and tests to ensure the selection of qualified candidates.
Select and monitor external vendors to ensure exceptional business practices, quality and cost assurance and their contribution to increasing claims close ratio.
Establish procedures with, and act as a liaison to other business units.
Handle and resolve escalated customer/client calls and complex contentious claims. Resolve claims issues by collaborating with team members, compliance and other internal/external stakeholders.
Represent Claims during meetings and inter departmental matters.
Represent Claim Department during internal/external presentations
Any other duties that may be assigned.
Supervisory Responsibilities:
Directly supervises 3 to 7 supervisors and manages the subordinates within the Claims Department. The Manager will carry out supervisory responsibilities in accordance with the organizational policies/procedures and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems/issues.
Desired Skills and Experience
To perform this job successfully, an individual must be able to perform each essential duty effectively.
Relevant LTC background is required, which includes understanding of how claims are processed from an end to end perspective. Also, to perform this job successfully individual should be well versed in using acronyms and terminology used in the LTC industry. Experience interpreting LTC contract language is desirable. Experience in understanding and interpreting state insurance regulations is preferred
The Manager is required to have advance product, company and function knowledge; ability to identify and coordinates resources to solve problem, reviewing recommendations regarding solutions to problems, and taking action to solve the problem; responsible for taking the initiative and influencing decisions within the department and/or organization. Proficiency in medical terminology, ICD-9/10, CPT/CDT coding is required. Insurance Industry and/or healthcare industry experience is a must. Manager must be professional and a team player.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Certificates, Licenses, Registrations:
AHIP, ICA and/or LOMA certifications desired.
Candidates:
Must have a Bachelor’s degree
Must have a stable career background
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