Claims Officer Leader
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The incumbent will oversee Voluntary Benefits Claims with responsibilities to include Dental and Vision Claims (including Group products across are Group Benefits Portfolio and Individual products in the Colonial Life portfolio). Ownership also includes closed block for the legacy Starmount direct to consumer products which span Voluntary products and individual Dental / Vision. The officer level leader will be accountable for overall claim adjudication, quality, and delivery on claim performance for Voluntary Benefits (VB) claims across both the Unum and Colonial Life Brands; each with completely different products and systems and distribution partners. The leader oversees significant claims processing counts with ownership over overall payment risk and processing of significant payments. VP oversees direct reporting leaders and overall ownership of team and its deliverables along with oversight of BPO FTE resources deliverables. Responsibilities includes oversight of claims adjudication and payment processing across many products. Specifically, these include distinct Voluntary Benefit claims for plans within Cancer, Critical Illness, Life, assigned LTC block. Accident, Hospital, Wellness (all products). In addition, the responsibility for all Dental and Vision claims coupled with the legacy Starmount block of business claims. This position is responsible to lead a high performing claims organization that ensures quality management of claims in a multi-disciplined, multi-geographical environment. The incumbent will be accountable for the collective financial performance, setting the strategic direction, and delivering on the overall operational objectives for claims areas supporting the Unum and Colonial Life brands This position may lead Director and Manager level team members who, in-turn, lead people leaders including partnerships with external partner leadership. In addition to overseeing the team's overall performance, this position has responsibility for attracting, developing, and retaining professional claims and leadership resources to achieve overall organization objectives and ensure bench strength for succession planning.
Principal Duties and Responsibilities :
- Provide vision, oversight and direction to claims processing leadership
- Facilitates strategic approach to processing and payment of claims while maintaining quality metrics that provide accountability measures to meet / exceed goals
- Identify, design, and implement opportunities for process enhancements, automation, and efficiency gains to improve overall delivery capabilities; support practice development to drive continuous improvement and consistency in delivery
- Manage a performance enhancement culture by actively coaching and mentoring direct reports, providing regular feedback and developing employees for wider roles and responsibilities to foster professional growth and development
- Manage budgeted resources by anticipating expenditures, accurately forecasting resource needs / costs and properly accounting for expenses to meet requirements and achieve fiscal responsibility
- Responsible for delivery of best-in-class customer experience in claims areas ensuring thorough fair and objective claim evaluations, providing the highest level of quality
- Implement claim management and quality claims decision strategies which support business objectives that will achieve best-in-class performance for our operations
- Responsible for the overall customer and provider claims relationship and enterprise customer satisfaction results as they pertain to claims service and experience
- Accountability for the delivery of BPO contracted services and quality
- Manage department performance to expectations for service standards for timeliness, accuracy, and risk management of claims including accountability for accurate administration of risk management programs and adjudication according to contract / plan provisions, established procedures, state regulations, Regulatory Settlement Agreement, Unum claim's philosophy and ERISA law, as appropriate
- Develop and manage department budget while looking for opportunities to optimize the total cost of operations, while not compromising on claim decisioning or quality
- Foster strong partnership with key, internal areas such as Benefits Compliance, Quality Assurance, Internal Audit, Policies and Procedures, Project Delivery, Learning and Development, and Talent Onboarding
- Partner with the Digital Transformation Office in directing significant technology change in the Claims Organization, serving as a primary representative of the claimant, plan administrator, provider, agent, and Unum / CLA employee experiences
- Partner with Product Development, Provider Relations, Underwriting, Sales, and Marketing areas to develop a productive and mutually beneficial relationship, including building market competitive products and processes that will attract and retain customers and providers
- Implement and effectively manage change with minimal disruption
- Support the sales organization in acquiring and retaining business, including support in RFPs, participation in customer finalist presentations, broker education and training and the development of effective sales / marketing materials
- Establishes a healthy and productive work environment that results in high levels of employee engagement and strong business results
- Assure alignment and integration of the claims with Benefits Services and Unum goals and vision
- Contribute to the overall effectiveness of Unum and Colonial Life through active participation in VB strategy development, planning, and prioritization of initiatives
- Cultivate a professional company reputation by upholding organizational values and sharing best practices with direct reports to keep communications consistent and aligned with company image
- May perform other duties as assigned
Job Specifications :
Minimum of five years of proven management skills in a multi-disciplinary operational setting12+ years' progressive professional experience in the insurance industry with a deep knowledge of assigned area product offeringExperience in organization development and process design and implementationRisk management experience in a variety of disciplines; voluntary benefits claims experience preferredAble to make balanced and objective decisions with the highest degree of integrityExperience leading and managing teams in multiple geographies. This is not limited to employee teams across Unum sites / remote. The role requires experience and demonstrates success running operations that include 3rd party vendors.In depth knowledge and understanding of sales distribution process and structure across all market segmentsAbility to identify market trends and needs; develop, execute and appropriately communicate solutions, both internally and externallyAble to design and execute on a vision that brings together technology, streamlined processes and people to create an exceptional client experience and delivers efficienciesStrong leadership qualities, including demonstrated ability to build strategic alignments with internal constituents and external vendor partnersAbility to influence internal / external audiences at various levels and with varying needsDemonstrated collaboration, partnership, and conflict management skillsProven relationship skills with external customers : employers, producers, claimants, agents, brokers, etc.Demonstrated presentation and facilitation skillsExcellent communication skillsBachelor's degree required; master's degree preferred or equivalent leadership experienceTravel required to Unum Campus locations, Field and to BPO partner locations as neededUnum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.
Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status. The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience. $144,900.00-$273,800.00 Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans.