Industry: Accounting, Finance & Insurance•
5 - 7 years
Posted 44 days ago
Description PRINCIPAL OBJECTIVES:
To contribute to the overall success of OneAmerica objectives by providing timely and accurate support to our client companies and the Claims department. To meet all key financial business objectives and enhance customer service levels for assigned team. To effectively manage the performance of all individuals to achieve optimal productivity. To strive for quality through accurate and timely claim decisions. To maintain clear and ongoing communications with other business partners, inside and outside of claim department, such as QA, Appeals, Training Team, Program Managers, Policy and Procedures, Underwriting, Legal, etc. Measurement standards include meeting/exceeding all financial indicators and quality requirements, and feedback from internal/external customers.
To provide leadership and coaching to staff, in the areas of: employee mentoring, employee recognition, employee motivation, and performance management. To have a positive impact on employee staffing and retention levels by participating in recruiting, hiring and retention strategies.
OneAmerica strives to ensure the independence and impartiality of all persons involved in making claim and appeal decisions. Accordingly, OneAmerica's decisions regarding hiring, compensation, termination, promotion, or other similar matters with respect to any individual are not made based upon the likelihood that the individual will support the denial of a benefit.
• Consistently adhere to the documented workflow guidelines and established procedures.
• Assure consistent, quality claims handling by review of all inventory and activity level reports (new claims, pending claims, diaries, past due activities, closures, reopens etc…Supports the response to and tracking of all Insurance Department complaints.
• Actively participates in review of claims for approvals/denials.
• Conducts one-on-one meetings with all claims staff on a monthly basis.
• Conducts timely, accurate performance assessments for all team members on an annual basis
• Partners with Team Leads in mentoring all staff to acceptable proficiency levels.
• Personally documents and addresses all performance management issues and communicates those to the Director of Claims.
• Interfaces weekly with Team Leads to remain abreast of team member performance and on-going training needs.
• Monitors caseloads to maintain consistency within team
• Analyzes claim activity reports to ensure adherence to turn-around times, workflow guidelines, etc.
• Supports/develops Team leads’ technical and mentoring capabilities.
• Ensures the Team provides excellent customer service by appropriately adjudicating claims within established service protocols.
• Responds to and documents customer complaints from claimants/their representative, clients and policyholders
• Ensures quality claim decisions in accordance with ERISA requirements and fair claim practices through participation in Team Meetings.
• Participates in customer presentations and visits with the goal of retaining existing customers and attaining new customers at the request of the Director of Claims.
• Reaches or exceeds approved quality rating requirements.
• Displays a high level of leadership through employee development, coaching and performance management.
• Strives to timely utilization of appropriate resources across the benefits organization.
• Participates in cross-departmental initiatives to enhance the overall effectiveness of the company at the request of the Director of Claims.
• Supports Policy Holder implementations
• Balance expense management by ensuring we have an efficient/consistent process
• May act as point of contact for client specific items based on client alignment.
Requirements • Four-year college degree or a combination of equivalent related work experience and education.
• A minimum of 5 years of experience managing disability claims is preferred.
• A minimum of 3 years of prior managerial experience required with the ability to effectively coach and mentor direct reports and their team’s performance
• Record of achieving team turn-around times and claim results following appropriate and fair claims practices and guidelines.
• Desired designations include: ICA (Insurance Claims Associate); HIA (Health Insurance Associate); LOMA, FLMI (Fellow Life Management Institute); CEBS (Certified Employee Benefit Specialist); etc.