Claim Service Manager - Remote or Hybrid

The Claim Service Manager is responsible for planning, organizing, directing, and controlling a Claim Service Team who process Accident & Health insurance claims. This role includes working as an autonomous claim examiner, along with managing a team of direct reports.

Essential Duties & Functions

Manager

• Interview, hire, train, and develop Claim Service Team
• Ensure legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations and enforce equally and fairly on team
• Analyze workload index and delegate responsibilities as needed
• Review monthly claim audits along with performance management that includes goal setting, feedback, disciplinary action, and rewards
• Developing performance metrics, goals, and best practices for both individuals and team
• Establish and maintain constructive relationships with customers, clients, providers, and other key stakeholders
• Monitor and provide feedback to Claim Management Leadership on the company’s proprietary claims system performance and areas of opportunity for system enhancements
• Create a workplace culture that is consistent with the company’s mission, vision, and values
• Assist in resolving complex claim and services issues
  
  

Claim Services

• Demonstrate fundamentally sound claim handling by achieving compliance in the areas of investigation, coverage and processing of claims
• Timely and appropriately communicate with the claimant and client, as well as internally
• Establish proof of loss by reviewing medical documentation; assembling additional information as required from outside sources; including claimant, client, provider, and other insurance companies
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
• Recognize and properly address coverage issues, potential fraud, and subrogation
• Ensure claim files are properly documented through internal notes and correspondence logs, and claim coding is correct
• Refer cases as needed to Vice President of Claims, Insurance Carrier, Program Management, and other appropriate parties internally and externally.
  
  

Job Skills

• Team Player
• Excellent verbal and written communication
• Behavior flexibility, ability to adapt management style
• Advanced critical thinking and problem-solving skills
• Strong decision-making ability and sound judgement
• Knowledge and understanding of Department of Insurance regulations
• Exhibits leadership qualities and forward-thinking mindset
• Ability to obtain and maintain Insurance Adjuster License
  
  

Job Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required/Preferred Education And Experience

Required Education: Bachelor’s Degree or comparable experience

Preferred Experience: 3-5 years insurance experience

Preferred Licensure: Accident & Health Adjuster License

Position Type and Expected Hours of Work

This is a full-time remote or hybrid position. Days and hours of work are Monday through Friday, 8:30 a.m. to 5 p.m. EST. The schedule for this role can be contingent upon Supervisor and Human Resources approval. Some evening and weekend work may be required.

Travel

Limited travel would be encouraged for trainings or team meetings. This would be discussed ahead of time and agreed upon between both Supervisor and employee.