We currently have an opportunity for a Sr. Claims Audit Manager to join our Operations team. The Sr. Claims Audit Manager leads quality control, leakage and closed file review programs for all facets of claims processing and handling for all specialty business. Responsible for ultimately seeing to the organization’s ability to efficiently handle and settle claims resulting in overall savings for the organization. Analyzes results and findings of campaigns, identifies trends and develops action plans and coordinates implementation of plans with various claims departments. Prepares and presents completed reports and findings along with associated cost savings to Claims Senior Management and others in the organization with a vested interest. Responsible for training and calibration of claims audit staff and/or other auditors as assigned to participate in claim review campaigns. Oversees all other audit activities as needed.
- Plans and leads execution of leakage programs and closed file review (CFR) campaigns for all facets of claims processing and handling. Reviews extend to all facets of Claims including but not limited to operations, vendor management, bill review and subrogation.
- Schedules and coordinates all CFR campaigns including training and calibration of auditors. Participate actively in campaigns as needed.
- Reviews, analyzes, prepares and presents completed reports and findings post campaign. Develops and communicates action plans to Sr. Management and claim managers regarding campaign results.
- Reviews and analyzes reports to identify and address trends. Develops and implements strategies to correct adverse trends. Works with Claim Management to develop necessary action plans to prevent leakage. Monitors and reports on executed action plans.
- Assists in preparation of analytics of leakage monitoring reports as needed. Works in conjunction with financial lead to identify and monitor cost savings.
- Based on campaign analysis provide feedback on claims best practices, technical triggers, claims legal triggers, state regulations and other criteria. Develops action plans and coordinates implementation of plans with various claims departments.
- Manages assigned staff, including development, goal setting, skill assessment, staff selection, role alignment, and performance appraisals of staff. Provides frequent communication and measurement of goals. Oversees training and personal development programs within the group.
- Oversees and manages all other Claim audit and quality control activities.
- Under minimal supervision, this position is responsible for the leakage and CFR campaigns within claims. Provides oversight to staff on these programs as well as otheraudit and quality control activities.
- Must have the skills needed to manage a staff. Has the authority to hire, terminate and other aspects of performance management.
- Takesinitiative in gettingthingsdone;operates with a sense of urgency in achievingbusiness results.
- Applies industry knowledge, technical skills and sound businesspractices to decisionmaking.
- Must be fully versed in insurance exposures, state insurance laws, corporate underwriting positions, and claims management philosophy.
- Must possess high level skills and extensiveclaimshandling and technical knowledge including products and industry.
- Exceptional management skills, including informal training and formal development of staff. Exceptional change management skills with the ability to lead via influence.
- Must have superior analytical, problem solving, planning, organizational and presentation skills. Must be a proven self-starter with strong multi-tasking and relationship management skills.
- Must be able to communicate professionally and effectively including expert oral, written and listening skills. Must be capable of delivering constructive criticism accurately and effectively to multiple levels within the organization.
- Must be able to work both independently and as a member of a team and have the ability to interact with and provide guidance to diverse groups of individuals, including peers and other members of Senior Management.
- Demonstrated proficiency with computer software including Microsoft Office suite and other Claims tracking tools.
Education and Experience:
- 10+ years’ experience handling claims, including experience with large losses; quality control experience is a plus (Band8)
- 5-7 years of supervisory/management experience. (Band 8)
- May manage a team of 1-6 professional auditor positions.
- Oversees other Sr. Claim professionals during review assignments.
- Responsible for ensuring that team achieves standards and annual business objectives.