Johns Creek, GA (USA)
Posted 60 days ago
Qualification: Bachelors degree from four-year College or university
Experience: Three to 5 years of related experience in an inbound call center and-or training - plus ten to fifteen years of industry related claims experience
We are searching for an experienced Director of Claims to join our team. The Director of claims exercises fiduciary and managerial responsibility over the entire claims area which consist of the processing of group health and individual policy medical, dental and vision claims. The Director of claims, plans, organizes, manages, and directs all functions and activities performed within the Claims Department in an effective and efficient manner so that claims service is maintained within established turn-around times and quality standards of Ebix Health Administrative Exchange; assures claims practices are in accordance with the standards and principles adopted by the International Claims Association (ICA) and the National Association of Insurance Commissioners (NAIC). Communicates with senior staff, agents, insureds and vendors as expert voice relative to claims processes.
ESSENTIAL DUTIES AND RESPONSIBILITIES OF THE DIRECTOR OF CLAIMS
- Manage to ensure appropriate staffing levels for all claims processes; interview and hire staff; assure proper orientation of new hires; maintain training and quality assurance programs to develop employees an address disciplinary issues as they arise.
- Supervise, direct, monitor, counsel and evaluate supervisory staff to ensure performance standards are maintained; establish individual and departmental goals; provide feedback and identify training opportunities to enhance skill levels of employees.
- Establish productivity and quality standards for each job classification within the department; develop and implement reports to track and monitor key result data (i.e. productivity and quality of employee performance, report card indicators on process results). Establish metrics to measure overall management and regularly report outcomes of Claims processes
- Identify opportunities for process improvements to reduce expenses and increase profitability. Sponsor projects and drive resources towards items that need improvement or reengineering that result in more favorable bottom line outcomes.
- Reviews and approves claim decisions, legal correspondence, claim audit submissions, which exceed supervisory staff authorization levels to ensure all communications, verbal and written, with all parties involved in claim disputes/grievances are properly researched, documented and professionally responded according to company standards and protocols.
- Ensures that all claims-paid data is properly transmitted to client companies, insurers, and appropriate Company departments, and that all banking transactions performed on behalf of clients are properly recorded and reported to all applicable parties.
- Serves as a mentor as well as a global and technical resource for staff and clients regarding claim adjudication. Assures claim practices and payments, negotiations and/or settlements are done timely and applied according to plan provisions and applicable state and federal regulations.
- Presents and ensures a professional image to claimants, agents, customers, vendors, and affiliated organizations through verbal interactions and written communication.
- Responsible for developing and adhering to department and corporate budgets.
- Performs other projects or job tasks as assigned by senior management.
EDUCATION and/or EXPERIENCE
Bachelor's degree (B. A.) from four-year College or university; or three to 5 years of related experience in an inbound call center and/or training; plus ten to fifteen years of industry related claims experience.
To be successful as the Director of Claims you must be able to perform of the essential duties listed above and meet the following requirements.
- Skilled in effective written and oral communication
- Strong ability to work independently and within teams
- Extensive leadership skills including performance management, staff development, and ability to motivate all employee types
- Ability to apply advanced subject matter knowledge to manage staff activities in solving common complex business/technical issues within established policies
- Ability to work independently Ability to handle multiple task and manage time effectively through many distractions.
- Strong leadership skills, with ability to make sound decisions based on deductive reasoning.
- Excellent PC and data entry skills with experience in MS Word, Excel and Outlook.
- Strong analytical and problem solving abilities.
- Clear and concise oral and written communication skills.
- Strong sense of propriety concerning confidential matters.
- Multi-tasking abilities with excellent documentation and follow up skills.
- Prior LuminX experience a plus.