Position Summary  

The Claims Manager is responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary. 

Essential Duties and Responsibilities 

The essential functions include, but are not limited to the following: 

• Identifies and resolves operational problems using defined processes, expertise and judgment 
•  Analyze and identify trends and provides reports as necessary
• Consistently meet established productivity, schedule adherence, and quality standards 
• Supervise, monitor, track and direct day to day operations of staff 
• Analyze and identify trends and provides reports as necessary 
• Develops plans to meet short-term and long-term objectives. 
• Demonstrates and Apply Knowledge of Internal Systems, Policies and Procedures 
• Will manage of a team of up to 10 employees, and hold staff accountable to individual and team metrics 
• Identifies solutions to non-standard requests and problems 
• Solves moderately complex problems and/or conducts moderately complex analyses 
• Works with minimal guidance; seeks guidance on only the most complex tasks 
• Provides explanations and information to all levels of leadership on difficult issues 
• Supervises, Coaches, provides feedback, to direct reports 
• Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit 

Minimum Qualifications (Knowledge, Skills, and Abilities) 

• 3 years of experience analyzing and solving customer problems in an office setting environment
• 2 years of experience in a supervisory role preferably within a production driven environment
• Capable of analyzing data and spotting trends or gaps that can be used to increase a team's efficiency
• Experience with direct reports, HR issues, employee development
• Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
• Moderate proficiency with computers and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Intermediate proficiency with MS Word (creating documents), Excel (sorting and filtering spreadsheets), Outlook and PowerPoint
• Knowledge of medical terminology or experience within the healthcare field
• Strong knowledge of commonly-used concepts, practices, and procedures within the insurance field
• Ability to balance customer and business considerations when making decisions