Manager, Claims Management

Position Summary...

What you'll do...

Supervises claim disputes by reviewing the claim file to evaluate claim disposition coordinating independent adjusters mechanical experts or estimate auditors findings in claim evaluation analyzing facts obtained during investigations to determine validity of claim and ensuring settlement or denial of the claim

Manages quality assurance reviews to improve claims handling procedures by performing quality assurance audits analyzing audit results for trends in claims handling compliance and developing solutions to improve communications to customers claims handling consistency adherence to claims handling procedures and claims adjuster training

Manages and implements the requirements and billing procedures of third party plans to ensure accuracy and compliance with government and commercially funded programs by interpreting third party requirements ensuring alignment with industry standards determining impact to current systems and processes collaborating with information systems division to identify and resolve system gaps communicating with stores and clubs to ensure understanding of new systems and implications and ensuring payer requirements are satisfied to improve efficiencies at store level reduce financial risk and meet centers for services requirements and industry billing standards

Minimizes the company’s legal exposure by securing services of outside legal counsel attending and participating in arbitrations auditing and paying outside counsel invoices assessing impact claim may have on case law and precedent prior to making payment on a claim and structuring complex settlements

Manages the continuous improvement of claims management initiatives and processes by developing and maintaining relationships with internal business leaders and external partners to improve claims handling performance and ensure business needs are met leveraging and analyzing claims data trends and future business needs to develop innovative strategies to improve efficiencies evaluating claims quality and processes through standardized reviews and audits monitoring performance of internal teams and third party providers reviewing and modifying claim system rules and compensation and general liability areas to identify areas for growth and capitalize on opportunities

Coordinates completes and oversees job related activities and assignments by developing and maintaining relationships with key stakeholders supporting plans and initiatives to meet customer and business needs identifying and communicating goals and objectives building accountability for and measuring progress in achieving results identifying and addressing improvement opportunities and demonstrating adaptability and promoting continuous learning Provides supervision and development opportunities for associates by hiring and training mentoring assigning duties providing recognition and promoting a belonging mindset in the workplace

 Ensures compliance with company policies and procedures and supports company mission values and standards of ethics and integrity by implementing related action plans utilizing and supporting the Open Door Policy: and providing direction and guidance on applying these in executing business processes and practices

Respect the individual: Demonstrates and encourages respect for all builds a high performing team seeks and embraces differences in people cultures ideas and experiences creates a workplace where all associates feel seen supported and connected through culture of belonging so associates thrive and perform drives a positive associate and customer member experience for all identifies attracts and retains the best team members

Respect the individual: Creates a discipline and focus around developing talent through feedback coach