Manager - Claims Management
The Claims Manager is responsible for leading a team of case managers in the management of workers' compensation or general liability claims from initial report to resolution. This role ensures timely, accurate, and compliant claims handling while driving engagement, performance, continuous improvement, and customer satisfaction.
Key Responsibilities :
- Manage end-to-end the case manager hiring process including screening, interviewing, selection, and onboarding.
- Lead, support, train, coach, and mentor a team of workers' compensation or general liability case managers.
- Manage team dynamics, resolving conflicts constructively and facilitating productive discussions.
- Lead by example, setting a high standard for performance, professionalism, and accountability.
- Foster a culture of belonging, collaboration, accountability, and continuous improvement.
- Promote individual and team engagement.
- Identify skill gaps and training needs and coordinate learning opportunities for team members.
- Conduct regular one-on-ones and performance check-ins to support employee growth, clarifying goals, and remove barriers for success.
- Provide timely and specific feedback to case managers through claim reviews, audits, performance metric reviews, and one-on-one discussions to enable career growth and improve claim outcomes.
- Complete root cause analysis to identify and resolve problems.
- Conduct performance evaluations and administer disciplinary actions.
- Be a champion of change; support and effectively lead through change.
- Mentor emerging leaders, building a pipeline of future leadership within the department.
Operational Oversight
Responsible for annual claim cost spend of up to $35,000,000.Assign new losses based on claim complexity matching to an appropriately tenured case manager with the necessary skill set to achieve an optimal claim outcome.Escalate claims to leadership based on the internal escalation guidelines and ensure the claims are reported to the insurers if applicable.Monitor inventory and caseloads to ensure workloads are appropriate and claims are moving through the lifecycle as efficiently as possible to prevent claim aging.Ensure timely and accurate investigation, documentation, evaluation, and resolution of claims in compliance with jurisdictional requirements.Oversee day-to-day handling of claims to ensure adherence to internal standard operating procedures and regulatory requirements.Review complex, high-exposure, and litigated claims and provide technical guidance on claim valuation, reserving, and claim strategy to achieve optimal outcomes.Provide reserve authority up to $400,000 and payment authority up to $75,000.Collaborate with legal counsel, stakeholders, and the employer to drive claim strategy.Resolve escalated complaints from the client, customer, or associate.Monitor the team's phone queue to ensure that customer needs are addressed timely.Quality Assurance & Compliance
Conduct claim reviews to ensure accurate coding, claim quality, accuracy, compliance with jurisdictional requirements, timeliness of benefits, and adherence to internal standard operating procedures.Ensure compliance with state laws, company policies, and client-specific service instructions.Maintain compliance with state audit and AIG requirements; provide a COE plan if results fall below acceptable requirements.Performance Monitoring & Reporting
Track and analyze key claims metrics such as inventory, closure rates, attorney representation rates, litigation rates, and return-to-work outcomes.Leverage "views" within the claim system to effectively manage inventory, ensure accurate claim coding, and ensure forward movement to prevent claim aging.Identify gaps in performance, processes or technology and complete a root cause analysis, develop an action, execute, and resolve.Collaborate with leadership to develop strategies for improving claim outcomes and reducing total cost of risk.Support cost containment strategies.Provide regular reporting on team performance, compliance findings, and strategic initiatives.Qualifications :
Bachelor's degree in business, Insurance, or related field or equivalent experience.Proven experience in claims management or a related field.Exceptional communication, interpersonal, and organizational skills.Professional designations, industry experience, and / or prior leadership experience preferred.The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a comprehensive inventory of all responsibilities and qualifications required of employees assigned to this job. The full Job Description can be made available as part of the hiring process.
Minimum Qualifications :
Bachelor's degree and 2 years' experience in insurance claims or relevant area OR 4 years' experience in insurance claims or related area
Preferred Qualifications :
Customer Service, Supervising Associates
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