Description
Senior level claims position to oversee a unit of 5-8 people and their respective caseloads. Manage your units claim metrics and ensure they are kept current. Oversee all aspects of file handling on pending claims which will include facts of loss, coverage analysis, investigation, negligence/compensability/liability determinations, damage assessment and coordination of medical care as appropriate. Approve and monitor litigation management, settlement negotiations, and appropriate use of vendor table. Establish and approve reserves as needed. Ability to attend conferences, client meetings, mentor adjusters and assist management as requested. Ensure files assigned to the unit are handled within state statutes, Client Claim Handling Guidelines and NARS Best Practices. Other miscellaneous duties as assigned, which may include travel.
Essential Duties and Responsibilities:
• Effectively supervise unit of 5-8 claims people and their respective caseloads in a proactive manner.
• Adhere to all file handling standards, NARS Best Practices, state statutes and requirements necessary to pass audits performed by regulatory agencies, carriers, and clients. Form well written emails and LLR's internally and externally.
• Demonstrate a strong commitment to the mission and values of the organization.
• Maintain strict confidentiality of client, company, and personnel information.
• Works closely with Quality Assurance to ensure company objectives are met.
• Review and respond to claim appeals and grievances, investigate, and respond to complaints.
• Adhere to the policy and procedures of NARS.
• Lead and manage by example to promote culture of service and continuous improvement.
• Provide leadership to achieve key business goals.
• Assign accountability for desired outcomes and hold adjusters to required dates.
• Communicate clearly and provide adequate direction.
• Track trends by program and unit – know the team’s claims when a client asks.
• Know the Team’s Clients and be able to confidently discuss their claims.
• Effectively manage corrective action processes in accordance with Human Resource guidelines.
Reserves:
• Responsible for overseeing adequate reserving of claims files and quality and efficient claim handling of files assigned to unit.
• Maintain appropriate diary on pending claims within the unit and ensure same for employees.
Team:
• Handle performance evaluations, attendance reporting and miscellaneous personnel issues.
• Conduct periodic one-on-one meetings to discuss goals/aspirations and SCORE, C3 diary, Skill set analysis to define strengths/ weaknesses & development needs.
• Conducting audits of adjusters, (2 files per month per adjuster).
• Routine analysis of pending and staffing for timely redistribution or requisitions, hiring, training and development.
• Create Individual Development plans and written training plans where appropriate.
• Coordinate HR functions with HR and the Department Director regarding progressive discipline.
• Conduct monthly Unit meetings to cover successes and areas of opportunity for improvement.
• Complete employee PE reviews within requested time frame with IDP and training plans included. Follow up with employee if not meeting deadline.
Litigation:
• Coordinates third party claim settlements with carriers, reinsurer, or plan administrators.
• Control and direct activities of defense counsel either directly or indirectly through staff.
• Responsible for approval of the assignment of legal defense of claims.
• Responsible for appropriate unit activities as relate to the litigation process, timely reporting of litigated files to management and round table discussions.
Customer Service/Contact:
• Responsible for client satisfaction, claim reviews and audit results for the unit.
• Handle all miscellaneous assigned duties and projects as assigned by upper management.
• Ensure program management, carriers and/or reinsurer receive appropriate claim notifications and referrals on large or potential large claims.
• Resolve customer complaints according to Best Practices, monitoring customer satisfaction in an effort to drive action plans for improvement.
• Follow up with Director on client issues and action plan for results on issues.
Review/Report:
• Conduct regular file reviews/audits for trend detection and correction of negative trends.