Supervisor of Claims Production

Description : PURPOSE :

PURPOSE :

The Supervisor of Claims Production is responsible for the management and operation of the Claims Analyst staff which includes production, quality review, personnel matters, workflow, claims procedures and training.

The Supervisor of Claims Production will have a detailed understanding of the computer system and working knowledge of the interaction of all functional units in the claims department.

This individual will be responsible for the career growth, development and planning for future needs to encompass the department as a whole and the individual claims staff members.

The primary focus is production, inventory management and quality of the unit.

ESSENTIAL FUNCTIONS :

40% 1. Management and operation of the unit in accordance with company objectives and guidelines as well as departmental guidelines and procedures, including workflow, procedures and processes, training, quality review and personnel matters : a.

Plan, direct and maintain the workload of staff. Coordinate staffing needs with Human Resources and interview prospective employees referred by H / R.

b. Develop and maintain employee developmental plans, fostering an environment which promotes growth and development. c.

Establish and maintain employee performance goals and minimum performance standards for both production and quality. d. Complete employee evaluations according to company guidelines.

Discuss evaluation with employees in a manner that motivates them to reach their potential for maximum job performance. e.

Counsel with individual employees concerning performance, personnel issues, etc. and establish corrective measures as necessary.

Resolve and / or direct questions or problems from staff members. f. Create and maintain job descriptions for all staff members.

g. Provide training as needed for new and existing staff.

10% 2. Establish, implement, and monitor all departmental guidelines and procedures. Oversee maintenance of departmental guidelines and procedure manuals.

15% 3. Analyze department production / quality figures. Evaluate results and communicate to staff on an individual basis to encourage their growth and development.

a. Evaluate, modify, or create new production / quality standards and procedures on an on-going basis and make recommendations to Claims Director.

5% 4. Consistently identify improvements (systems and processes) to improve performance and quality.

2% 5. Randomly audit files reviewed by the Claims Auditors to determine appropriateness of the errors and to review for consistency.

13% 6. Communicate with other members of the Claims supervisory team to plan and direct the workflow throughout the Claims Department and take action on situations that arise between the different areas of Claims.

3% 7. Consult with the Team Leads and other Claims Supervisors on the progress of trainees throughout the training process.

Assess progress and take appropriate action.

2% 8. Respond to or direct staff to answer situational questions from Customer Service Representatives via Contact Management System.

2% 9. Resolve problem telephone calls referred by upper management and respond accordingly. Refer files to the Analysts to expedite actual processing or reprocessing.

2% 10. Provide assistance with managing any offsite office maintenance and business transactions (Rockford).

2% 11. Organize and execute schedule of onsite office meetings (Trimester) to include company sponsored lunches / events.

Management retains the discretion to add or change the functions of this position at any time.)

MARGINAL FUNCTIONS : 4%

1. Answer technical questions on claim files referred by the Carrier or internal staff, or external questions by insureds, agents, providers, etc.

and periodically process problem or complicated files.

2. Contact the Carrier by telephone or written correspondence regarding specific claims or policy interpretation as required.

3. Assist in case management functions. Answer questions and review benefit reduction appeals and / or denials as required.

Communicate with vendors to establish referral procedures and to resolve any questions or problems that arise.

4. Review and evaluate employee suggestions. Encourage and develop employee contributions in team problem solving and their ideas for process improvements.

5. Prepare for and meet with external auditors when necessary

Requirements :

1. One year of experience in a lead, quality or supervisory role. Insurance experience, including claims processing, strongly preferred.

2. High school graduate or equivalent. A college degree or college coursework is preferred.

3. Demonstrated decision making abilities.

4. Ability to speak English fluently. Ability to read, comprehend, follow, and give written or verbal English instructions.

5. Excellent interpersonal skills. Ability to listen and question employees to determine level of understanding and / or define problems.

Ability to express self clearly in a courteous, confident, and consistent manner.

6. Ability to compose proper business correspondence. (i.e., letters, memos, and file documentation).

7. Excellent telephone communication skills, (i.e., listening for understanding, responding accurately and professionally).

8. Ability to perform basic math skills.

9. Ability to operate in a ten-key calculator and proficiency in using a personal computer, i.e., spreadsheets, databases, reports, etc.

10. Ability to meet company attendance requirements and work extended hours as needed.

11. Ability to work under and handle stress associated with varying workloads and deadlines.

12. Ability to sit or stand for 7.5 hours a day.

FACTORS IMPORTANT TO SUCCESSFUL PERFORMANCE OF POSITION :

Problem solving Analytical ability Interpersonal skills Dexterity Communication skills Coaching and mentoring Supervisory / Leadership

The position requires the ability to evaluate employee's performance and take corrective or disciplinary action accurately, consistently, and fairly.

Excellent communication and interpersonal skills are needed in verbal contact and written correspondence internally and with those outside of the Company.

Must have analytical and creative abilities to solve problems and project future needs of the department.

PHYSICAL DEMANDS OF POSITION :

Standing / Sitting 90% of time Attend / conduct meetings, reviewing files. Walking 10% of time Meetings, reference area and to monitor employees. Lifting / Carrying 20 lbs

NOTE : Applicants who need accommodation for an interview or job testing, please request this in advance to the Human Resources Department.

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