Paid Leave Claim Manager - Employee Benefits (Remote)

Logoslabs; San Francisco (CA); Remote; USD 110,000 - 140,000; Full time

Job summary

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.

Qualifications

• 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).

Responsibilities

• 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).

Skills

Supervisory skills

Time management

Communication

Problem solving

Education

Bachelor’s degree

2+ years claims examiner experience

Tools

Microsoft Office

Job description

Job Summary:

Oversees the day to day operations of an assigned claims examining team/unit.

The incumbent will be responsible for supervising and advising claims examiners in all phases of the adjudication process and for the performance of each of the team’s members (e.g. team player, quantity, quality, etc.).

***This role will be titled Manager Claims within the organization.***

Responsibilities

• 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).

Qualifications/Education/Experience

• 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).

Employee Benefits:

We aim to protect the wellbeing of our employees and their families with a broad benefits offering. In addition to offering comprehensive health, dental and vision insurance, we support emotional wellbeing through mental health benefits and an employee assistance program. Work/life balance is important and Protective offers a variety of paid time away benefits (e.g., paid time off, paid parental leave, short-term disability, and a cultural observance day). The financial health of our employees is just as important as physical and emotional health. Some of the financial wellbeing benefits include contributions to healthcare accounts, a pension plan, and a 401(k) plan with Company matching. All employees are encouraged to protect their overall wellbeing by engaging in ProHealth Rewards, Protective’s platform to improve wellbeing while earning cash rewards.

Eligibility for certain benefits may vary by position in accordance with the terms of the Company’s benefit plans.

Accommodations for Applicants with a Disability:

If you require an accommodation to complete the application and recruitment process due to a disability, please email [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application and recruitment process.

Please note that the above email is solely for individuals with disabilities requesting an accommodation. General employment questions should not be sent through this process.

We are proud to be an equal opportunity employer committed to being inclusive and attracting, retaining, and growing an inclusive workforce.