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Permanent Claims Team Lead

Syracuse, New York

Post Date: 03/21/2017 Job ID: 8127 Category: Professional

Job Description:

 

•           Supervise the operation of multiple teams of examiners and technical staff for single or multiple product lines which administer workers compensation and/or general liability claims for clients

•           Monitor colleagues' workload, provide training, and monitor individual claim activities

•           Provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims

•           Supervise multiple teams of examiners, single of multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.

•           Identify and advise management of trends, problems, and issues as well as recommended course of action; inform management of new procedures and ideas for continuous process improvement; and coordinate with management projects for the office

•           Provide technical/jurisdictional direction to examiner reports on claims adjudication

•           Compile, review and analyze management reports and take appropriate action

•           Perform quality review on claims in compliance with audit requirements, service contract requirements, and quality standards

•           Act as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.

•           Review reserve amounts on high cost claims and claims over the authority of the individual examiner

•           Monitor third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.

•           Maintain contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.

•           Assure that direct reports are properly licensed in the jurisdictions serviced.

•           Ensure claims files are coded correctly and adequate documentation is made by claims examiners.

•           Administer company personnel policies in all areas and follow company staffing standards and training recommendations.

•           Interview, hire, and establish colleague performance development plans; conduct colleague performance discussions

•           Provide support, guidance, leadership and motivation to promote maximum performance.

 

Qualifications:

 

•           High School Diploma, Bachelor’ s Degree preferred

•           Six (6) years claims experience or equivalent combination of education and experience required.  Two (2) years claims supervisor experience preferred.

•           Thorough knowledge of claims management processes and procedures for multiple product lines

•           Licenses as required – NEED to have NY Worker’ s Compensation (WC) Claims Experience

•           Excellent oral and written communication, including presentation skills

•           PC literate, including Microsoft Office products

•           Leadership/management/motivational skills

•           Analytical and interpretive skills

•           Strong organizational skills

•           Excellent interpersonal skills

•           Excellent negotiation skills

•           Ability to work in a team environment

•           Ability to meet or exceed Service Expectations

•           Credit security clearance, confirmed via a background credit check, is required for this position.

•           No telecommuting

•           5 to 6 examiners report to the supervisor

•           Examiners will have case load of 140

 

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