Lead, Paid Leave Claims — Compliance & Quality

Logoslabs; San Francisco (CA); A distancia; USD 110.000 - 140.000; Jornada completa

Descripción de la vacante

ShelterPoint seeks a Manager Claims to oversee day-to-day operations of a claims examining team in the SF area. The role supervises and mentors examiners, ensures workflow efficiency, and advises on complex adjudication matters to maintain high production and quality standards.

You will work with management to implement policy changes, monitor performance, and participate in staff development, training, and interviewing.

Formación

• Represent the ShelterPoint brand with the utmost professionalism
• Bachelor’s degree and two (2) years experience as a Claims Examiner is preferred.
• Prior experience in supervising, mentoring, training and/or leading others is preferred.
• Ability to organize time, set priorities, and manage workload.
• Knowledge of disability adjudication principles, methods, procedures and current business practices
• Demonstrated ability and willingness to give candid and meaningful feedback
• Knowledge of current federal and state laws pertaining to leaves of absence
• Knowledge of medical terminology
• Being Responsible and Reliable is a must
• Ability to adapt to change
• Excellent supervisory skills – teaching, coaching, mentoring and leading others.
• Excellent interpersonal skills and ability to build effective working relationships with a variety of constituencies
• Professional verbal and written communication skills
• Independent problem-solving skills - ability to analyze, interpret and apply rules and regulations of considerable complexity
• Ability to work in a fast pace environment
• Proficient in Microsoft Office (i.e. Word, Excel).

Responsabilidades

• Supervises and advises claims examiners in all phases of the adjudication process.
• Schedules, assigns and oversees the work of their respective claim examiners. Quickly identifies and resolves workflow and caseload management challenges.
• Utilize knowledge to monitor the team’s output for: uniformity in the application of processes, compliant with regulations, and adheres to or exceeds departmental standards of service.
• Ensure team members achieve, and preferably exceed, ‘current’ departmental production goals and quality standards.
• Resolves issues above the skill set of the claim examiners (i.e. act as SME). Responsible for special handling policies/claims (i.e. white glove).
• Confers with manager and/or other SMEs to resolve escalated/unique claim related issues.
• Provides feedback to management on workflow, work priorities and production problems. Recommends changes. Works with other supervisors to develop policies and strategies to advance the work of the department.
• Implements required programmatic and business process changes/enhancements.
• Reporting to management on various activities of the team both verbally and in writing.
• Promotes a positive customer experience through prompt, accurate and courteous service to both internal and external customers.
• Contribute to positive work environment to ensure the achievement of departmental and corporate goals and objectives (outside of Claims).
• Participates in department’s various project work and assignments, as needed.
• Initiates production of daily check reports. Verifies that issued checks balance to control totals. Places stop payments and voids on all returned checks. Records all overpayments and liens, including phone follow-up.
• Participates in interviewing and selection of staff. Hires and trains staff involved in processing claims.
• Provides counsel, guidance and support to examiners regarding their performance, as measured by the performance standards of the department
• Identifies and leads in-service training and staff development needs. Provides ongoing coaching and mentoring.
• Conducts performance evaluations that are timely and constructive.
• Establish and implement corrective action plans, when necessary.
• Assumes delegated responsibilities when the Manager is unavailable for a material amount of time (i.e. out of office).

Conocimientos

Supervisory skills

Time management

Communication

Problem solving

Educación

Bachelor’s degree

2+ years claims examiner experience

Herramientas

Microsoft Office

Descripción del empleo

ShelterPoint seeks a Manager Claims to oversee day-to-day operations of a claims examining team in the SF area. The role supervises and mentors examiners, ensures workflow efficiency, and advises on complex adjudication matters to maintain high production and quality standards.

You will work with management to implement policy changes, monitor performance, and participate in staff development, training, and interviewing.