WC Regional Manager, Claims (Remote - Residency in Western States)

Blue Cross Blue Shield of Michigan; United States; À distance; USD 100 000 - 158 000; Plein temps

Résumé du poste

Blue Cross Blue Shield of Michigan is seeking a senior leader to oversee a regional workers' compensation claims organization, driving claim quality, customer experience, and financial stewardship. This role leads claim professionals and support staff, ensuring regulatory compliance and a culture of accountability.

The position requires multi-jurisdictional workers’ compensation expertise, strong leadership, and the ability to align departmental goals with strategic objectives while traveling as

Qualifications

• Bachelor’s degree in a related field.
• Seven (7) years of experience in a claim environment with demonstrated technical experience.
• Three (3) years of supervisory or leadership experience in claims.
• Previous workers’ compensation claim management with multi-jurisdictional experience preferred.
• Bilingual skills preferred.

Responsabilités

• Manages monoline workers' compensation unit of claim professionals and support staff.
• Leads claim team in support of department initiatives and strategies in cost containment, case file handling, customer service and quality.
• Develops unit goals, objectives, processes, procedures and systems.
• Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation advancements.
• Identifies team staffing needs and takes necessary measures to ensure appropriate levels of service.
• Mentors employees and develops career paths with growth opportunities.

Connaissances

Leadership

Budget management

People management

Communication skills

Regulatory compliance

Claims management

Multi-jurisdictional experience

Bilingual skills

Formation

Bachelor’s degree in a related field

Description du poste

SUMMARY

Provides leadership for a regional workers' compensation claims organization in accordance with claims adjudication and benefit allocation. Responsible for the overall performance of claims operations, including claim quality, customer experience, workforce development, financial stewardship, regulatory compliance, and operational effectiveness. Leads claim professionals, and support staff in achieving organizational goals while promoting a culture of accountability, continuous improvement, collaboration, and service excellence.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

1. Manages monoline workers' compensation unit of claim professionals and support staff.
2. Leads claim team in support of department initiatives and strategies in cost containment, case file handling, customer service and quality.

• Consistently monitors workflows to maximize accuracy and efficiency. Maintains an acceptable level of service and customer satisfaction and retention.
• Effectively manages the quality review process.
• Develops unit goals, objectives, processes, procedures and systems.
• Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation advancements.
• Identifies team staffing needs and takes necessary measures to ensure appropriate levels of service.
• Mentors employees and develops career paths with growth opportunities.

1. Participates in development of annual departmental budget, monitors budget and identifies budget discrepancies. Researches cause of discrepancies and makes recommendations.
2. Participates in special projects and serves on committees as needed.

EDUCATION AND EXPERIENCE

Relevant combination of education and experience may be considered in lieu of degree.

• Bachelor’s degree in a related field.
• Seven (7) years of experience in a claim environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities.
• Three (3) years of supervisory or leadership experience in claims required.
• Previous workers’ compensation claim management with multi-jurisdictional experience preferred.
• Bilingual skills preferred.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

OTHER SKILLS AND ABILITIES

• Knowledge of team building and employee motivation theories with the ability to effectively manage multi-functional employee teams.
• Demonstrated leadership abilities.
• Knowledge of laws, regulations and compliance requirements related to workers’ compensation insurance.
• Demonstrated technical knowledge of insurance administration, claims management or relevant insurance expertise.
• Ability to work with and empower others on a collaborative basis to ensure success of unit team.
• Excellent oral and written communication skills.
• Knowledge of insurance and underwriting techniques, agency and policyholder needs.
• Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
• Ability to establish workflows, manage multiple projects and meet necessary deadlines.
• Ability and proficiency in the use of computers and company standard software specific to position.

SUPERVISORY RESPONSIBILITIES

Directly supervises a varied number of employees in the designated department(s). Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

ADDITIONAL INFORMATION

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.

WORKING CONDITIONS

Work is performed in a virtual office with no unusual hazards. Travel is required, with some occasional overnight stays. Must possess a valid driver's license with a record that meets corporate standards. Must be able to meet general physical requirements that would allow the ability to view and participate in account operations which may include climbing ladders and scaffolding, work in confined spaces, and or other similar situations.

Pay Range - Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between$100,000 and$158,350.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

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