Claims Technical Lead

Jobtailor; Farmington (CT); On-site; USD 95,000 - 130,000; Full time

Job summary

Jobtailor in Farmington, CT is seeking a claims team leader to guide case managers and ensure high-quality outcomes. You will mentor new hires, participate in training, and monitor performance metrics to meet service levels.

Ideal candidates have 4+ years in a related field, with 2+ years in case management for STD/LTD or absence management, plus strong communication and change leadership abilities. This role involves collaboration with leadership and team oversight.

Qualifications

• Bachelor's Degree in Health Administration or Business.
• 4+ years of related experience in claims/case management.
• 2 years of case management experience in STD/LTD, Life, Absence Management or related field.
• Equivalent combination of education and experience accepted.

Responsibilities

• Act as main point of contact for claims-specific questions from case managers.
• Mentor new hires and support new-hire training.
• Participate in refresher training and development of existing staff.
• Ensure case managers use appropriate risk-management skills to secure appropriate claim outcomes.
• Conduct manager reviews and audits of claims to ensure overall quality.
• Provide coaching and feedback to case managers.
• Monitor KPIs and reports to ensure service levels and commitments are met.
• Monitor and adjust workload balancing for case managers.
• Support management in facilitating team meetings and huddles.
• Periodically manage complex cases and customer escalations.
• Elevate trends and coaching opportunities to the leadership team.
• Complete special projects and ad hoc assignments requested by leadership.
• Perform other related duties as required.

Skills

Leadership

Communication

Critical Thinking

Influencing Change

Mentoring

Education

Bachelor's Degree in Health Administration

Bachelor's Degree in Business

Tools

Contracts Understanding

Risk Management

Claims Auditing

Job description

• Act as a main point of contact for claims-specific questions from case managers
• Mentor new hires and support new-hire training
• Participate in refresher training and development of existing staff
• Ensure case managers use appropriate risk-management skills to secure appropriate claim outcomes
• Conduct manager reviews and audits of claims as necessary to ensure overall quality
• Provide coaching and feedback to case managers
• Monitor KPIs and reports to ensure service levels and commitments are met
• Monitor and adjust workload balancing for case managers
• Support management in facilitating team meetings and huddles
• Periodically manage complex cases and customer escalations
• Elevate trends and coaching opportunities to the leadership team
• Complete special projects and ad hoc assignments requested by leadership
• Perform other related duties as required

Requirements

• Ability to influence and champion change
• Excellent critical thinking and decision-making skills
• Strong leadership and organizational skills
• Excellent verbal, written, and presentation communication skills
• Strong understanding of contracts, plans, and products
• Strong knowledge of best practices and effective case management skills
• Bachelor's Degree in Health Administration, Business, or a related field
• 4 or more years of job-related experience
• 2 years of case management experience in STD/LTD, Life, Absence Management, or a related field/industry
• Equivalent combination of education and experience accepted

Core Competencies

Demonstrates strong leadership and organizational skills while effectively managing case managers and ensuring quality outcomes. Possesses a solid understanding of case management practices and the ability to influence change within the team.

Highest-signal resume keywords

• Case Management Experience
• Leadership Skills
• Critical Thinking
• Communication Skills
• KPI Monitoring

Hard Skills

• Risk Management Skills
• Claims Auditing
• Contract Understanding
• Best Practices in Case Management
• Decision-Making

Soft Skills

• Mentoring
• Coaching
• Organizational Skills
• Influencing Change
• Presentation Skills

Certifications & Qualifications

• Bachelor's Degree in Health Administration
• Bachelor's Degree in Business

Industry Keywords

• STD/LTD
• Life Insurance
• Absence Management
• Claims Management
• Customer Escalation