Mgr, PLADS Claims Operations

Job Summary

Manager of a front line claims operational team is responsible for the direct supervision of Case Managers, operational results, and performance of those Case Managers. Also involved in direct customer and sales interaction as it relates to our process and case management.

Principal Duties & Responsibilities

• Oversees daily operations of multiple levels of staff and multiple functions across one or more

   business units

• Manages day to day site operations and accountability for financial and non-financial results (budgets and actuals)

• Provides expertise or general claims support to teams in reviewing, researching, investigating,

   negotiating, processing, and adjusting claims

• Attends/participates 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 cross-functional activities

• Authorizes the appropriate payment or refers claims to investigators for further review

• Analyzes and identifies trends and provides reports as necessary

• Leads project management and implementation initiatives

• Supports employee development by conducting regularly scheduled 1x1s with direct reports

• Provides appropriate oversight to ensure team successfully achieves targets to meet performance guarantees

• Performs other related duties as required

Education & Experience Required

• Bachelor’s Degree in related field
• 5+ years of claims industry 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
• Proficiency within Microsoft Excel (ability to create pivot tables, basic formulas, sorting, and read data)

Or an equivalent combination of education and experience

Education & Experience Preferred

• Operation Excellence (Six Sigma) experience

Job Knowledge & Skills

• Ability to be proactive

• Sense of Urgency

• Time Management Skills

• Ability to follow through with daily tasks

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