PLADS Claims Technical Specialist

Job Summary

Serves as the claim and/or leave subject matter expert providing support to the Operations leadership team as well as a mentor for case managers.

Principal Duties & Responsibilities

• Acts as a main point of contact for claims specific questions for the case managers

• Serves as a mentor for new hires as well as supports new hiring training

• Takes an active role in refresher training and developing of existing staff

• Ensures case managers are utilizing appropriate risk management skills to secure the appropriate claim outcome

• Conducts manager reviews/ audits of claims as necessary to ensure overall quality

• Provides the appropriate coaching and feedback to case managers as needed

• Monitors KPIs and reports to ensure service levels and commitments are met, working with case managers as needed

• Monitors and adjusts workload balancing for case managers

• Provides support to the manager in facilitating team meetings/ huddles

• May periodically manage very complex cases directly

• Elevates any trends and / or coaching opportunities to the leadership team

• May manage customer escalations

• Completes special projects and/or ad hoc assignments as requested by the leadership team

• Performs other related duties as required

Education & Experience Required

• Minimum Required Bachelor’s Degree In a related field.
• Minimum Required 5-year minimum industry experience
• Minimum Required 2 years minimum experience working with employees

Or an equivalent combination of education and experience

Job Knowledge & Skills

• Ability to influence and champion change

• Excellent critical thinking and decision -making skills

• Strong leadership and organizational skills

• Excellent Communication skills (verbal, written & presentation)

• Strong understanding of contracts, plans and products

• Strong knowledge of best practices and effective case management skills

Competencies

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