Claims Manager Job Description

Claims Manager Job Description

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Claims manager provides support to ensure regulatory compliance with state licensing statutes, municipal ordinances, city codes, licensing laws and administrative rules and procedures to include any major regulatory changes that affect licenses and registrations of assigned businesses.

Claims Manager Duties & Responsibilities

To write an effective claims manager job description, begin by listing detailed duties, responsibilities and expectations. We have included claims manager job description templates that you can modify and use.

Sample responsibilities for this position include:

Supporting and promoting process improvement methodologies and best practices that enhance claims service and increase employee satisfaction and engagement
Recruits, selects, develops, manages, motivates, coaches, and mentors Risk Console coordinators
Manage and handle all claims in accordance with Starr's Minimum Standards, Starr internal procedures and any local regulations
Support the underwriters by keeping them informed of claims developments
Monthly formal feedback and coaching sessions with direct reports
Monitoring and reporting key performance metrics, and providing regular trend analysis
Approving and disallowing claims within authorization limits
Assisting with recruitment, hiring, training and development of staff
Supporting claims initiatives and projects as assigned
Contributing to the team’s success by partnering with others to review operating procedures and processes, ensuring that the best possible service is maintained and the ultimate customer experience is provided

Claims Manager Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Claims Manager

List any licenses or certifications required by the position: PMP, FEMA, ASE, AIC, CPCU, LOMA, ARM, SCLA, L&I, GER/GAR

Education for Claims Manager

Typically a job would require a certain level of education.

Employers hiring for the claims manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Education, Management, Business, Business/Administration, Finance, Law, Accounting, Performance, Graduate, Leadership

Skills for Claims Manager

Desired skills for claims manager include:

Mortgage/ Lender systems
Practices
Medical terminology
Services being delivered by branch office
Entire claims administration
Regulatory rules
Licensing and regulatory requirements of industry and ensure compliance of employees in unit
Negotiating skills
Statutes and procedures governing the jurisdictions assigned to ensure compliance
Case management and cost containment solution as applicable to Workers’ Compensation

Desired experience for claims manager includes:

Commitment to superior customer servicing
Commercial Insurance Agents License preferred
3 Years claims experience - or
3 Years Marine Industry Experience - or
Bachelor’s degree in Insurance/Risk Management
Experience drafting diverse documents

Claims Manager Examples

1

Claims Manager Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of claims manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for claims manager
  • Work with HR Services to further automate the Ergonomic request feature such that our MyHR system can respond, possibly directly with Zurich or an outside vendor
  • Work with HR and other internal and external strategists toward process improvements at the plants to systemically alter exposure to worker injuries such as repetitive injury
  • Establish new workers’ compensation claim review processes at plants, to include line-level or local management
  • Work with plant management to establish detailed injury coding methodology toward early detection of claim trends, enabling early systemic intervention
  • Work with plant management to bring appropriate safety and ergonomic resources to assist with needed systemic intervention toward thwarting injury trends
  • Globalize reach of employee-related injury and injury prevention and mitigation to extend to non-US operations, to include tracking/managing equivalent or similarly intended social, private or government schemes for injured workers outside the US
  • Provide budget support for budgeted claims figures and allocation
  • Manages and provides one-on-one guidance and oversight to claim examiners to achieve compliance standards
  • Reports compliance performance issues to management in written and/or verbal formats
  • Participates in the development and implementation of claim processing related departmental polices, standards and procedures
Qualifications for claims manager
  • Medical education background preferred
  • Bachelor's degree and at least 8 years of risk management or insurance experience
  • Experience in Claims Handling
  • Property Casualty insurance claims required
  • Analytics experience required
  • Legal / Contract Management degree or Engineer degree with knowledge gained in contractual and legal matters
2

Claims Manager Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of claims manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for claims manager
  • Ensure compliance with internal strategies, policies, procedures and knowledge and identify skill or procedural gaps detrimental to the center's operation
  • Develop and implement programs that ensure highest level of quality as the department scales to meet growing claims activity
  • Identifies training needs and content to address skill gaps
  • Monitors call activity statistics and KPIs to include but not limited to queue status, AR, ASA, ACW and AHT
  • Presents analysis, reporting and corrective actions to address any performance gaps
  • In conjunction with the Group H&S Manager, ensure that all sites are fully aware of their responsibilities regarding Accident Investigation and that they are following the correct procedures accordingly
  • Liaise with sites to ensure the provision of accurate and timely information relating to new and ongoing claims
  • Provide a strong and supportive management process for liaising with sites to ensure all systems for the retention of information are correct and timely
  • Manage and represent the business for on-site visits relating to Claims, ensuring Operations Directors are fully conversant with the Claims details and the reasons for any visits
  • Attend quarterly file review meetings with the Solicitors to discuss specific areas of concern and related financial implications
Qualifications for claims manager
  • Demonstrable knowledge of claims handling and procedures
  • Adjuster License, ARM or CPCU, preferred
  • Requires strong understanding of risk mitigation and claims management strategies, including regulatory and jurisdictional requirements
  • Strong familiarity with carrier claims systems and with generating reports
  • Proven ability to effectively manage claims prioritize a high volume of complex matters simultaneously
  • Strong interpersonal skills and the ability to effectively communicate orally and in writing to management, employees and others outside the organization
3

Claims Manager Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of claims manager. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for claims manager
  • Monitor and provide status reports for pre-acquisition claim proceeding trial
  • Conduct Risk Management orientation training as needed
  • Develop and make recommendations for educational Risk Management programs based on needs assessment
  • Reviews and approves, within assigned authority limits, claim expenses and settlements that exceed the claim adjuster’s granted authority
  • Conducts regular reviews of pending and closed files to determine whether claims are processed appropriately
  • Reviews contracts for insurance coverage, indemnification requirements
  • Utilizing management tools, resources and business routines, monitors work performance for standardization and consistency
  • Works cross-functionally with other departments to address customer or business issues and resolve errors in a timely manner
  • Maintains current and complete awareness of products and services to effectively provide direction and respond to issues that claims processors may encounter
  • Communicates and resolves complaints via telephone and e-mail from customers or their representatives, agents, adjusters, examiners, contractors
Qualifications for claims manager
  • Must be good with math
  • Must possess a comprehensive understanding of all relevant laws and regulations governing Property and Casualty claims in the US, Canada & Puerto Rico
  • Demonstrated ability to manage a staff of at least 7 people
  • Knowledge of supervisory techniques and interpersonal skills
  • Ability to effectively communicate precise directions to staff members
  • Superior negotiation skills and ability to deal effectively with plaintiff attorneys and direct staff on those skills as well
4

Claims Manager Job Description

Job Description Example
Our company is looking to fill the role of claims manager. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for claims manager
  • Serve as a liaison between insured, carrier, defense attorneys
  • Closely monitor litigation status on elevated claim files and provide assistance as needed
  • Advocate on the client’s behalf for coverage issues that may arise
  • Request and distribute currently valued loss runs for policies prior to renewal and upon request
  • Provide detailed loss summaries
  • Provide location specific loss letters upon request
  • Participate in annual and mid-term claim reviews with client and carrier representatives
  • Generate and distribute weekly incoming incident reports in excel format from the claims system to internal staff each Monday for the previous week
  • Generate weekly claim reports in excel format for the client each Monday
  • Assist with handling renters’ insurance claims per the client’s request
Qualifications for claims manager
  • Ability to cross-train with Risk Analyst
  • Comprehensive understanding of all relevant laws and regulations related medical and legal terminology
  • Where applicable, passed state licensing requirements for line(s) of insurance handled
  • 15 years claims processing, claim appeal, and claim audit experience
  • Previous Supervisor/Manager experience in a Managed Care environment
  • Medicare/DOI audit experience
5

Claims Manager Job Description

Job Description Example
Our company is looking for a claims manager. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims manager
  • Supervise, train and direct reports in the areas of their responsibilities
  • Work with the Quality Manager, Claims Supervisors and under the direction of the CIC General Manager to review reports to ensure accurate and timely completion of all reject related work
  • Develop relationships with Omnicare operations and billing staff to facilitate a smooth integration and maintenance of the reject management process
  • Participate in annual/semi-annual review process and lead employee counseling for the Claims Area, as needed
  • Supervises staff, evaluates performance and terminates as necessary
  • Participates in organization decision making structure and process by attending meetings and actively participates in discussions
  • Engage and develop our ways of working across Lab , SRC and DMI at a Shanghai HUB level
  • Maximize and optimize the claims labs approach and deliverables across métier
  • Define & Implement the process of developing impactful and consumer relevant claims
  • Ensure that we leverage off the performance dossier to drive the development of claims and communications
Qualifications for claims manager
  • Must have great people development skills
  • Proven ability to manage multiple tasks simultaneously while producing quality results in an evolving, fast paced environment
  • Proven ability to establish and maintain collaborative partnerships across the organization
  • Proven ability to see the “big picture”, leading a team to make strong and reliable recommendations for claims resolution
  • Some travel required to meet with management, subsidiaries, vendors and to attend mediations
  • A minimum of 10 years claims experience across all classes of insurance

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