Plans and leads the work of a dedicated claims team personnel, including directing work assignments, scheduling and reviewing work-in progress.
Monitors team work flow and redirects as needed to ensure continued prompt and accurate claims service.
Manages staff, with responsibility for hiring, performance management and coordinating training and development.
Anticipate and identify problem areas and develops, implements and evaluates procedures to correct the problem leading to more accurate, prompt claims service to the client, increase the overall effectiveness and efficiency of the claim team and ensure uniformity and consistency in all procedures
Reviews and handles all escalated, complex, or special claims cases including denials and pended claims to settle or initiate further action within approved authority limits.
Successfully able to negotiate escalated claim issues with carrier executive leadership
Responsible for reducing reimbursement turnaround times and pended/denied claim log.
Takes initiative to problem solve issues as needed which could include educating the stop loss team, health & welfare team, executive leadership team and third-party administrators on claim philosophies, market updates and best practices.
Review data sources to deliver reporting on key claim and reimbursement metrics which provide insight into team and carrier performance including carrier loss ratios
Represents Lockton Dunning to outside agencies, such as the client, third party administrators, vendors and outside counsel in a manner that ensures continued excellent relations with all parties.
Maintain executive relationships with carrier or partner claims leadership teams
Oversee policy year end claims reconciliation process and report results
Bachelor’s Degree in business or related field or equivalent education and experience.
7 to 10 years in claims industry with 3 or more years of management experience.
Demonstrated ability to effectively communicate and negotiate to achieve results through influencing others within and outside the organization.
Analytical and detail oriented with ability to discern larger organizational picture and act accordingly.
Proficiency in Microsoft Word, PowerPoint and Outlook
Intermediate to advanced experience with Excel including pivot tables and formulas
Proven critical thinking and problem solving skills.
Excellent organizational and communication skills.