Claim representative Jobs in San Diego, CA

JOB DESCRIPTION

Essential Duties & Responsibilities :

Performs a combination of duties in accordance with departmental guidelines :

Leads the work activities of medium to high severity specialized Claims Professionals and / or Claims Managers and has full management responsibility for executing the Claims Leadership Playbook by setting and communicating expectations, providing direction and situational coaching, facilitating ongoing training and development, and managing employee performance.

Contributes to organizational profitability by driving productivity, managing expenses, ensuring appropriate use of vendors, overseeing and authorizing claim resolution strategies, and ensuring quality and customer service standards are met or exceeded.

Ensures customer satisfaction by holding team accountable to deliver high quality and timely claim service, identifying service opportunities, and developing initiatives, processes and training that contribute to a positive customer experience.

Ensures applicable claim handling protocols are followed by maintaining and / or overseeing appropriate file engagement, monitoring quality dashboards, providing ongoing feedback and addressing training needs.

Regularly uses data analytics to monitor team(s) performance, and develops strategies to drive operational effectiveness, and improve the overall performance of the organization.

Responsible for effectively managing department and claims expenses by achieving productivity targets, efficiency and quality standards, appropriately leveraging internal and external resources, and using data analytics to identify trends and opportunities.

Ensures optimal and effective operation by developing and maintaining collaborative business partnerships with internal and external resources while recognizing connections and inter-dependencies and maximizing relationships to effectively manage the operation.

Effectively communicates and shares pertinent and timely information to employees by holding team meetings, regular 1 : 1 employee discussions, reinforcing leadership messages and providing shared access to company process and protocol documentation.

Participates with senior leadership in the development, implementation and reinforcement of claim handling protocols, business strategies and objectives, and regularly evaluates performance; holding self and team accountable for achieving desired results.

Oversees compliance with state / local regulatory requirements by following company guidelines, and remains current on commercial insurance laws, regulations or trends for line of business.

May participate in special projects.

May perform additional duties as assigned.

Reporting Relationship

Typically AVP or above

Skills, Knowledge & Abilities

Thorough knowledge of the insurance industry and the organization's products, policies and procedures.

Ability to effectively recruit, lead, coach, develop and retain talented claim professional and / or managers.

Advanced technical expertise in a specialized or highly complex line of business, business management acumen, investigation and claims resolution experience, expert knowledge claims principles, practices and procedures.

Ability to solve complex issues with a sense of urgency; utilizes and effectively identifies and manages all available resources to make informed decisions.

Ability to effectively interact and collaborate with all levels of CNA's internal and external business partners.

Excellent communication skills and customer service experience, with demonstrated ability to succinctly present to senior management.

Demonstrated knowledge and understanding of when and how to extract insights from metrics to make informed business decisions.

Ability to creativity and effectively manage through ambiguous and challenging business problems, lead through change and take appropriate levels of risks.

Adaptable and able to effectively lead through change.

Knowledge of Microsoft Office Suite and other business-related software.

Ability to model CNA's leadership behaviors.

Education & Experience :

Bachelor’s degree with Master’s preferred or equivalent experience.

Typically a minimum of ten years of related work experience, with three years of management experience preferred

Applicable certifications or professional designations preferred.