Mgr, PLADS STD/Leave

Job Summary

The Manager, STD/Leave is responsible for management and administration of multiple functions, or management of general business operations within Disability Claims Department.

Principal Duties & Responsibilities

Oversee daily operations of multiple levels of staff and multiple functions across one or more business units

Manage day to day site operations, and accountability for financial and non - financial results (budgets and actuals)

Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting Insurance and Leave of Absence claims

Attend/participate in select customer meetings as appropriate to discuss feedback and/or needed process enhancements.

Initiates and maintains partnerships with others throughout the organization. Encourages cooperation by promoting common goals and building trust. Inspires, supports, and initiates crossfunctional activities.

Authorize the appropriate payment or refers claims to investigators for further review

Analyzes and identifies trends and provides reports as necessary

Lead project management and implementation initiatives

Identifies trends and assist in developing creative solutions to improve overall efficiencies of Short Term Disability and leave of Absence processes

Analyzes and distribute daily reports and ensure Performance Guarantees and critical claim indicators are consistently met

Consistently cascade critical compliance and process updates to team members; provides appropriate oversight to ensure team successfully achieves targets to meet Performance

Guarantees; supports employee development by conducting regularly scheduled 1x1s with direct reports; coaches and develops direct reports to advanced claim management practices

Performs other related duties as required

Education & Experience

Bachelor's Degree in a related field, 5+ years of claims industry experience, or an equivalent combination of education and experience.

5+ years of Supervisory, Managerial, and / or leadership experience in claims adjudication or customer service

2+ years of experience managing relationships with clients and / or vendors

2+ years of experience managing budgets, process improvement and quality assurance

Operation Excellence (Six Sigma) experience (preferred)

Job Knowledge & Skills

• Experience using specific medical and/or behavioral health criteria or protocols

• Extensive clinical experience/knowledge

• Strong customer service skills

• Strong written and oral communication skills.

• Strong organizational and time management skills

• Ability to analyze clinical records in the context of functional capacity

• Kean instincts on how to work in a team environment

• Pass Applicable certification and licensing continuing education and maintain active license and/or certification, as required.

• Seeks and/or maintains current or enhanced profession credentials.

• Proficiency within Microsoft Excel (ability to create pivot tables, basic formulas, sorting, and read data)

• Solid understanding of the regulations governing FMLA, Statutory Disability and ERISA as it relates to absence programs

Organizational Competencies

Acting with Integrity, Communicating Effectively, Pursuing Self-Development, Serving Customers, Supporting Change, Supporting Organizational Goals, Working with Diverse Populations

Leader Competencies

Acting as a Champion for Change, Demonstrating Initiative, Developing Talent, Managing Performance