Senior Manager - Claims Manager

Desired
skill and responsibilities:

Position
Title: Sr. Manager, Claims

Department: Operations

Reports
to: AVP, Operations

Location: Horsham, PA

Position
Overview

The
Sr. Manager of Claims Ancillary Services will be responsible for the overall
planning and implementation of training, reporting, project management/business
analysis for process/technical system improvements, and the triage team
responsible for escalation services and complex issue resolution, improving
efficiency and implementing productivity improvements resulting in a client
focused service delivery. Will also
monitor and control costs while maintaining exceptional service levels, and
determine strategies that will increase the company’s profitability.

ESSENTIAL
DUTIES AND RESPONSIBILITIES include the following (Other duties may be
assigned)

Provide
leadership and guidance to Supervisors to develop highly skilled, result
oriented and customer focused teams that consistently meet and/or exceed
service levels and performance standards.Establish
clear and concise performance standards and service levels and implement
processes that monitor gap analysis and incorporate corrective action planning.Oversee
the set up and delivery of strategic training programs for inexperienced and
experienced claims employees and encourage external training.Develop,
recommend and implement strategic programs and procedures that encourage
customer loyalty, company profitability and cost effective productivity.Oversees
the development of written procedures and guidelines for the measurement of
quality, quantity and service goals.Key
contributor to analysis and control of reporting with oversight of development
of reporting layouts and metricsAnalyzing
report results, monitoring trends and variances and recommending actions to
managementOversight
of multiple teams to include training, reporting, case escalations and Business
Analysts, setting service deliverables to ensure SLA metrics are metDetermine/manage
priorities, timelines and schedulesWork
to identify process improvement opportunities, develop solutions and best
practices.Ensure
all tools, processes and procedures are properly documented within SOP’sLead
and participate in cross-functional project teams; lead and provide feedback to
managers who are not direct reports

SUPERVISORY
RESPONSIBILITIES

Directly
supervises and manages the subordinates within the Shared Services
Department. The Manager will carry out
supervisory responsibilities in accordance with the organizational
policies/procedures and applicable laws. Responsibilities include interviewing,
hiring, and training employees; planning, assigning, and directing work;
appraising performance; rewarding and disciplining employees; addressing
complaints and resolving problems/issues.

QUALIFICATIONS

To
perform this job successfully, an individual must be able to perform each
essential duty effectively.

Relevant
LTC background is required, which includes understanding of how claims are
processed from an end to end perspective.
Also, to perform this job successfully individual should be well versed
in using acronyms and terminology used in the LTC industry. Experience interpreting LTC contract language
and skill in researching and responding to complex customer complaints is
desired. Experience in understanding and
interpreting state insurance regulations preferred. Reasonable accommodations
may be made to enable individuals with disabilities to perform the essential
functions.

Proven
problem solving and business analysis skills, creating and resourceful in
identifying issues and developing solutions.Proven
communication/collaboration skills with the ability to design departmental
structureExceptional
attention to detail with ability to analyze data in a meaningful wayAble
to effectively articulate issues and trends to managementSelf-motivated,
able to work independently with minimal supervision and in team environmentAbility
to multi-task in a fast-paced , ever changing environmentDemonstrates
ability to coordinate complex projectsPossesses
strong ability to draft analysis narrativesGood
organizational and planning skills

EDUCATION
and/or EXPERIENCE

College
degree or 5+ years related experience and/or training; or equivalent
combination of education and experience.

LANGUAGE
SKILLS

Must
have the ability to read and interpret documents such as policies and operating
and procedural manuals; Ability to write routine correspondence; Ability to
speak effectively to customers, clients or employees of the organization.

COMPETENCIES

Critical
Thinking; Customer Service; Work Standards; Decision-Making; Communication;
Interpersonal Skills; Integrity/Honesty and Adaptability/Flexibility

MATHEMATICAL
SKILLS

Must
have the ability to add, subtract, multiply, and divide in all units of
measure, using whole numbers, common fractions, and decimals; Ability to
calculate figures and amounts such as discounts, interest, and percentages.

REASONING
ABILITY

Ability
to apply common sense understanding to carry out instructions furnished in
written, oral, or diagram form; Ability
to deal with problems involving several concrete variables in standardized
situations.

PHYSICAL
DEMANDS

The
physical demands described here are representative of those that must be met by
an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.

While
performing the duties of this job, the employee is regularly required to
sit. The employee frequently is required
to use hands to finger, handle, or feel.
The employee is occasionally required to reach with hands and arms and talk
or hear. The employee must regularly
lift and/or move up to 10 pounds.
Specific vision abilities required by this job include close vision, and
ability to adjust focus.

WORK
ENVIRONMENT

The
work environment characteristics described here are representative of those an
employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.

Work
environment is in office. The noise
level in the work environment is usually low to moderate.