Claims Examiner Supervisor - 2307

- OUR VALUES MAKE US A BETTER COMPANY FOR ALL -

 

Our values including RESPECT FOR PEOPLE, INTEGRITY, INITIATIVE, COMPETENCE, AND LEARNING guide us to be the best company for both our employees and customers.  People who share our values, you have an excellent opportunity to thrive in our open, progressive and team-oriented environment. Long Term Care Group (LTCG) is the nation’s largest administrator of long term care insurance services.  We provide a sophisticated and broad platform of services, including full policy administration, clinical expertise, and product design and development for both group and individual long term care insurance products.

 

ABOUT OUR BENEFITS

Long Term Care Group offers a very complete competitive benefits package including health, dental, life and long term care insurance.  We also offer a 401k plan, vacation, and a flexible spending plan for medical and dependent care expenses.

 

ABOUT THIS OPPORTUNITY

In this position, you will provide leadership and technical direction to the Claims Support and Examiner team, which is primarily outsourced to ensure that claims are handled promptly, accurately and efficiently. You will also manage vendor results and interact with subject matter experts and have responsibility for system enhancements, issues and testing.

 

Hours: M – F (Hours could include an occasional evening)

Travel: Some travel

# of People on Team: 1-3

# of People in Dept.: 50

 

RESPONSIBILITIES

1.  Assign and supervise claims support and examiner staff with about 3 people and oversee the outsourcing of the majority of the claims exam work. 

2.  Organize the day to day workflow, monitor day to day production and reporting, and review quality of training for off shore staff and on-site employees.

3.  Ensure work is completed in a timely manner to meet customer expectations, which includes assisting with the internal hiring process and any human resource issues. 

4.  Assists staff including the outsource vendor with questions and problems relating to claims administration and completing quality reviews. 

5.  Handle non-routine claims which include communication with existing clients on special claim exam issues. This may include training on new processes and clients with the outsource vendor.

6.  Provide input towards system re-design for improved efficiency & quality. 

7.  Develop new and on-going procedures and policies for new and existing clients, including revising existing policies and procedures. 

8.  Communicate with director/manager about problems involving team operations such as workflow & claims services including client development activity.

9.  Interact with claims and care manager supervisors, policy technical analysts, and off shore vendors.

10.  Other duties and projects as assigned.

 

QUALIFICATIONSBachelor’s degree or equivalent work experience required5+ years claims experience required preferably in Health or Long Term Disability insurance and at least 2 years leadership experience3+ years experience in claims processing system design5+ years experience in client audits Proficient with MS Word, Excel, Outlook, and some working knowledge with AccessPrevious vendor management preferred as well as extensive knowledge of claims system & proceduresAbility to lead staff or manage off shore vendor activities including ability to organize, prioritize, motivate and promote team workProvide excellent customer service to both internal and external customers Ability to exercise judgment on questionable claimsGood interpersonal skillsExcellent written and verbal communication skills

 

TO APPLY CLICK THIS LINK>> https://home.eease.com/recruit/?id=54271

 

TO LEARN MORE ABOUT US visit http://www.ltcg.com/.  While we do not sell or distribute long-term care insurance, our goal is to make a difference in the lives of the people we serve at a time when they need it the most.

 

EOE m/f/d/v