Manager, Claims Job Description

Manager, Claims Job Description

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Manager, claims provides technical guidance to claim team members, Producers and Account Managers concerning Workers Compensation statutes and claims best practices.

Manager, Claims Duties & Responsibilities

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

Sample responsibilities for this position include:

Assist HR Dept
Analyze claims and strategize with insurance carrier adjusters and defense counsel on claims resolution
Review all reserve and settlement requests from insurers
Schedule and participate in claim reviews
Reconcile monthly claim payment funding requests/invoices for Liberty Mutual, Zurich, ACE and Gallagher Bassett
Review and revise claims handling instructions as necessary
Produce quarterly loss experience reports for review by Director
Provide assistance with policy renewal activities
Manages the corporate global insurance renewal process for all property and casualty insurance placements
Negotiates and manages multi-year global risk insurance broker contracts

Manager, Claims Qualifications

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

Licensing or Certifications for Manager, Claims

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

Education for Manager, Claims

Typically a job would require a certain level of education.

Employers hiring for the manager, claims 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 Manager, Claims

Desired skills for manager, claims include:

Claim file process through presentation of actions and responses to client questions
Accepted industry standards and practices Computer experience with related claims and business software
Accepted industry standards and practices
California Labor Code for those Examiners in California
Practices & procedures and current case law
York’s Best Practices and client Account Instructions
York’s claim system and internal workflows & procedures
Team member related functions
Medical terminology
Property claims contracts and interpretation of case law

Desired experience for manager, claims includes:

International profile and good communication skills
3 to 5 years of experience in personal care / Fast moving consumer goods industry working in the field of claims /regulatory / product evaluation
Effectively communicate and defend one’s position within the company and outside the company
Strong organizational skills, attention to detail and timelines, especially on urgent matters
Possess the ability to persuade and negotiate on behalf of the clients with carriers to obtain information, commitment, or payments
Demonstrated knowledge of claim procedures, coverage analysis, reserve techniques and dispute resolution

Manager, Claims Examples

1

Manager, Claims Job Description

Job Description Example
Our growing company is looking to fill the role of manager, claims. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for manager, claims
  • Oversee and direct the day-to-day management of the claims program to ensure the proper and efficient handling of claims, gathering of information on claims for both record keeping and loss forecasting purposes, and estimating the financial value of the claim
  • Ensure that coverage analysis and decisions regarding extension or denial of insurance coverage are appropriately evaluated and communicated to Management
  • Responsible for the implementation and practice of all claims handling guidelines and directives outlined in the Special Service Instructions (“SSI”) with the third-party administrator (“TPA”)
  • Manage and set strategy for annual motor vehicle program
  • Responsible for post loss reduction techniques such as salvage, subrogation and rehabilitation
  • Special projects, tasks and duties as assigned by Management
  • Will be responsible for managing/leading a team of 3 individual contributors while also assuming a leadership role in cultivating an innovation mindset across USCM Claims
  • Manage and increase the effectiveness and efficiency of Client Services through improvements to each function coordination and communication between support and business functions
  • Monitors the accuracy, completeness, & the appropriateness of billings
  • Work with HR Services to "automate" WC claims reporting such that the MyHR system connects with Zurich's WC claims reporting system seamlessly
Qualifications for manager, claims
  • Insurance basics with Medical products
  • 4 year college degree is a must, a Business related field is highly preferred
  • ARM, CPCU, AIC preferred by not required
  • Proficient in use of Risk Management Information Systems
  • Proficient in use of Microsoft Excel, Word, PowerPoint
  • Requires full knowledge of claims processing and working knowledge of another functional area
2

Manager, Claims Job Description

Job Description Example
Our growing company is hiring for a manager, claims. 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 manager, claims
  • Interacts with internal departments, Health Plans, providers and with any external contracted companies ensuring compliance with all current legislation
  • Creates weekly and monthly claim metric reports for management and health plans
  • Assist in analyzing reports prior to claims released to payment on check runs
  • Oversee the appeal/review function and perform level III appeals
  • Provides support to Network Services in resolving provider claim queries
  • Responsible for coordinating Health Plan claim audit requests and reviewing audit results for accuracy
  • Conducts business in compliance with the corporation’s Code of Business Conduct
  • Performs 90 day reviews and annual evaluations of appeal/review and special project examiners
  • Develop and execute the claims center performance quality programs
  • Drive, monitor and report on service and adjudication consistency in handling claims processes and procedures
Qualifications for manager, claims
  • Ability to work on own initiative and a “self starter”
  • Experienced in the use of Word, Excel and Outlook
  • Excellent planning and organisational skills with proven experience of prioritising a pressured workload
  • Demonstrated supervisory experience required, managing a claim operation preferred
  • Minimum of 5 years’ experience in worker’s compensation claims adjusting or claims management
  • Must be willing to travel as needed, but no more than 10%
3

Manager, Claims Job Description

Job Description Example
Our company is looking for a manager, claims. 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 manager, claims
  • Highlight areas of improvement and cost control regarding Claims Management
  • Manage the claims process in order that trends and weaknesses within the business are highlighted and learned from
  • Delivery of a quarterly Claims Report for the attention of Site Directors and the plc Board
  • Facilitate the delivery of training across the business regarding the implementation of any changes relating to Claims and assisting with the delivery of continuous improvement and preventative actions
  • Possessing and applying a thorough understanding of all major classes of insurance in response to broker and client enquiries, managing the claim process and preparing claim submissions to Insurers
  • Ensuring that appropriate claims management strategies are developed and implemented on all complex/large claims
  • Developing and maintaining relationships with insurers, solicitors and adjusters
  • Identifying and monitoring the accuracy and performance of team members, to assist the State Claims Manager to take necessary corrective action ensuring performance and services continue to meet client and Company expectations
  • Building technical and non-technical expertise and skills of team members by identifying development needs, attending internal and external learning events and mentoring and coaching team members in conjunction with the State Claims Manager
  • Conduct internal reviews in coordination with defense counsel, insurance representative and claims committee member
Qualifications for manager, claims
  • Experience in project management, with experience in managing across a multi-dimensional organization
  • Solid, analytical, organization, communication and presentation skills, with experience and comfort presenting to executive leadership
  • Strong record of results from prior roles
  • Demonstrated ability to manage and drive a culture of customer-centricity
  • Familiar with P&C insurance a plus
  • Licensed Claims Adjuster for 5+ years, with a current Texas Adjuster's License
4

Manager, Claims Job Description

Job Description Example
Our growing company is hiring for a manager, claims. 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 manager, claims
  • Produce claims for the Client, including Extension of Time claims
  • Prepare claim status reports to Management Team on a regular basis
  • Coordinate with other project team members to identify client related actions or inactions, which result in constructive contract changes
  • Provide principal support to the Project management team in the effective administration of the prime contract between EJV and its client DBJV
  • Take appropriate actions to protect EJV interest
  • Identify and prepare comprehensive claims documentation and coordinate the efforts to negotiate and help to resolve claims with the Design Built Joint Venture (DBJV)
  • Draft contractual commitment documents , particularly responding to contractual letters
  • Close coordination with planning and change management team
  • Review all incoming Commercial Property & Casualty incident reports and determine level of severity
  • Delegate claims reporting responsibilities to claims associates for handling
Qualifications for manager, claims
  • Medical degree/background (medical doctor) or insurance related degree
  • Has been working in life/health insurance is an advantage
  • The incumbent should be degree- qualified, or be a professional associate or fellow of a recognized commercial institution
  • Proven experience in the management and analysis of claims
  • Availability to travel outside the country
  • Attainment of the Associate in Claims designation, & successful completion of, or active study for, I.I.A.MGT 41, MGT 42, SM18 & SM19, or the equivalent in related studies or work experience
5

Manager, Claims Job Description

Job Description Example
Our company is hiring for a manager, claims. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for manager, claims
  • Build and develop relationships with the claims management provider ensuring robust management of TPA performance
  • Ensure claims are serviced in accordance with agreed contractual terms
  • Review format, content and frequency of audits, performance data and KPIs
  • Ensure reports and MI meets the requirements of internal stakeholders and actively used to drive positive outcomes
  • Be a technical referral point to handle claims outside of DA limits
  • Implement performance management frameworks to Benchmark Claims TPA performance
  • Develop a go-forward strategy for travel claims management
  • Work with the Professional Services Manager and under the guidance of the CIC General Manager/CIC Senior Director to create procedures that will enhance workflow and create efficiencies
  • Oversee work to ensure all daily tasks are completed
  • Work with the Follow-Up/Retro Supervisor to prioritize and monitor retro reports to ensure timely resolution
Qualifications for manager, claims
  • Proven success in managing call center operations
  • Must be detail oriented with organizational and follow up skills ( self-starter)
  • Claims adjudication skills or licensed insurance professional
  • Bachelor’s degree with 10+ years’ claims management experience in a corporate risk management department, insurance broker or insurer with a demonstrated ability to act as a liaison and to provide quality claims service
  • Strong understanding of claim management concepts, practices and procedures, with the ability to analyze data and formulate action plans
  • Proven strong leadership and problem solving skills

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