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Claims Supervisor

This position supervises and coordinates the activities of a designated team of Claims Representatives and/or Claims Assistants and participates in the management and administration of the department. This position contributes to the technical adjudication of specialized claims. This position reports to the Director of Claims. 

EDUCATION AND EXPERIENCE

  • Bachelor's degree from a four-year college or university preferred;  
  • Minimum three years of experience in the insurance industry or related field preferred;
  • Previous experience as a Lead or Supervisor preferred;
  • Must possess proficient knowledge of standard concepts, practices, regulations, and laws within insurance field.

KEY POSITION RESPONSIBILITIES (other duties may be assigned): 

Claims Management and Administration

  • Review and manage all claim files assigned to team ensuring the following:
  • All policies and procedures are being followed;
  • Proper reserves are maintained on each claim file;
  • Claim payments, expense payments, and commission protection are accurate;
  • Proper file documentation is collected and maintained including all records of correspondence and telephone conversations;
  • Internal/external investigations are being monitored and directed appropriately;
  • Verification that no coverage is available for all denied claims;
  • Review and respond to Department of Insurance complaint letters;
  • Review and prepare request for reconsideration;
  • Respond to written and phone inquiries regarding claims status; 
  • Issue expense checks for services rendered;
  • Process claims in a timely, efficient and accurate manner;
  • Provide back-up phone support with EMT provider after hours;
  • Establish and process EMT claims;
  • Ensure that current Federal and State insurance claims regulations, laws, and best practices are being employed consistently for all jurisdictions;
  • Assist with strategic planning, development and review of claim departmental procedures.

Team Supervision and Training

  • Supervise, train, develop and coach team members and other employees as required utilizing performance management tools and ensuring that department and company policies and standards are being met and followed;
  • Assist in the interview process and hiring of new team members;
  • Maintain work schedules for team including vacation and other time off and ensure adequate coverage is being provided at all times;
  • Manage and conduct performance reviews for direct reports and provide measurable benchmarks and goals for each team member;
  • Distribute daily work assignments to team members.

Auditing and Reporting

  • Monitor large losses, litigation and denials and report to the underwriter;
  • Review various month end reports to reconcile data in open and closed files;
  • Conduct quarterly inactive claims file audits;
  • Conduct monthly active file case review.

Administrative Coordination and Support

  • Develop and maintain strong interdepartmental relationships and contacts with the Sales & Marketing Department and Customer Service Department as well as other teams as needed;
  • Work closely with other departments in order to assist them with claim issues as well as to keep informed of policy/project changes within the Company;
  • Participate in review committee meetings;
  • Participate in meetings as a member of the department management team;
  • Maintain proficient working knowledge of Claims Operating Systems and provide support to team should they need assistance;
  • Perform other duties/special projects as assigned by the Claims Manager or Executives.
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