Future Medical Claims Examiner | Brea, CA

Claims Team Lead, Auto | Total Loss

Full-time · Telecommuter GA
✓ Verified live on the employer's own system · added 6 days ago
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Junior · 2+ yrs exp

Requirements

Education: Bachelor's degree

Experience: 2+ years

Skills & tools

ManagementOperationsProcess ImprovementRecordkeepingHiringTeam LeadershipCommunicationsMS Office
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Full job description

- Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit. - Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office. - Provides technical/jurisdictional direction to examiner reports on claims adjudication. - Compiles reviews and analyzes management reports and takes appropriate action. - Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards. - Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal. - Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner. - Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client. - Assures that direct reports are properly licensed in the jurisdictions serviced. - Ensures claims files are coded correctly and adequate documentation is made by claims examiners. - Performs other duties as assigned.

- Administers company personnel policies in all areas and follows company staffing standards and training recommendations. - Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions. - Provides support, guidance, leadership and motivation to promote maximum performance.

Education: Bachelor's degree from an accredited college or university preferred.

- Licenses as required. Professional certifications as applicable to line of business preferred.

Experience: Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years total loss claims supervisor experience.

Skills: thorough knowledge of claims management processes and procedures for multiple product lines, excellent oral and written communication, including presentation skills, PC literate including Microsoft Office products, strong organizational skills, excellent negotiation skills, and ability to work in a team environment

Work environment requirements include - Physical: Computer keyboarding Auditory/visual: Hearing, vision and talking Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

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This posting was published by Future Medical Claims Examiner | Brea, CA on their own careers system and is shown here with a direct link to apply there. Employers: for corrections or removal, contact jobs@veritahire.com.