Auto Liability Claims Manager
To supervise the operation of multiple teams of examiners and technical staff for single or multiple product lines which administer workers compensation and/or general liability claims for clients; to monitor colleagues' workload, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES:
- Supervises multiple teams of examiners, single of multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.
- Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.
- Provides technical/jurisdictional direction to examiner reports on claims adjudication. • Compiles, reviews and analyzes management reports and takes appropriate action.
- Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
- Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
- Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.
- Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.
- Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.
- Assures that direct reports are properly licensed in the jurisdictions serviced.
- Ensures claims files are coded correctly and adequate documentation is made by claims examiners. ADDITIONAL FUNCTIONS and RESPONSIBILITIES • Performs other duties as assigned.
- Supports the organization's quality program(s). SUPERVISORY RESPONSIBILITIES:
- Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
- Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
- Provides support, guidance, leadership and motivation to promote maximum performance. WORK ENVIRONMENT: When applicable and appropriate, consideration will be given to reasonable accommodations.
- Thorough knowledge of claims management processes and procedures for multiple product lines
- Licenses as required
- Six (6) years claims experience or equivalent combination of education and experience required.
- Two (2) years claims supervisor experience preferred.
- Baccalaureate degree from an accredited college or university preferred.
- Professional certifications as applicable to line of business preferred.