Claims Team Lead – Liability

Claims Team Lead – Liability

Requirements

• Must reside and be licensed in Louisiana
• Bachelor’s degree from an accredited college or university preferred
• Six (6) years of claims experience or equivalent combination of education and experience required to include two (2) years claims supervisor experience
• 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
• Leadership/management/motivational skills
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

Responsibilities

• 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
• Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client
• 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

Preferred Qualifications

• Professional certifications as applicable to line of business preferred