Claims Manager - Professional Liability (Medical Malpractice - Pharmacy, Dental and Vet)

Pharmacists Mutual Insurance has an opening for a Professional Liability Claims Manager. This position will ensure superior delivery of claims services and products. The manager will also direct, coordinate, and monitor the activities of a team of claims employees and/or other parties assigned to manage the Company's claims, such as Third-Party Administrators and MGAs. The manager will provide consulting and training resources and serve as a contact and technical resource to external and internal business partners.  

Claims Manager

• Ensures timely and appropriate claim decisions and resolutions.
• Engages with the Claims team leadership to develop and implement strategic programs that meet our Company's goals and objectives.
• Assesses performance and growth needs of team members and engages in development discussions.

Essential Functions

Essential functions may include, but are not limited to the following:    

• Timely decision making and action to meet Company guidelines and goals.
• Provides quality customer service by monitoring performance and establishing metrics.
• Resolves complaints, problems, and coverage questions which have been escalated through the team.
• Establishes focus of the team to properly manage Company indemnity & expenses.
• Recommends appropriate cases for discussion for claims roundtable; Attends and/or presents at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expenses.
• Ensures that the Company’s claim quality, guidelines and metrics are successfully met.
• Assigns staff to attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
• Evaluates the work of assigned staff and prepares written performance evaluations; makes recommendations on personnel actions to include hiring, work assignments, training, and discipline.
• Manages relationships with large accounts and brokers from a claims and risk management perspective.
• Works with and manages a third party administrator and/or external business partners as applicable.

Knowledge, Skills and Abilities

• Understand principles and practices of insurance claims examination.
• Knowledge of employee management principles including hiring, supervision, training, retention, and performance evaluation.
• Conduct investigative interviews.
• Understand employee management and developing standards.
• Manage process, planning, and tracking of budgets.
• Correct English usage, spelling, grammar, vocabulary and punctuation.
• Ability and flexibility to work longer hours when workload fluctuations occur.
• Research and stay up-to-date with trends and changes in the claims/insurance industry.
• Communicate effectively with others (oral and written).
• Analyze complex issues and make critical decisions.
• Maintain records, prepare reports and conduct correspondence related to the work.
• Interpret and apply laws, rules and regulation, as well as complex policy and contract coverage.
• Obtain and use sensitive information discreetly and objectively, both internal and external.
• Determine when to escalate concerns to the