To ensure product quality and regulatory standards compliance by line-of-business; to establish policies and procedures;
and to develop and train colleagues on technical components of new programs.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Establishes policies and procedures to assure compliance to best practices, claims management services standards, state regulations, and client service requirements on new programs.
Analyzes management reports related to new program performance and quality; mentors new colleagues to improve performance as needed.
Maintains complete understanding of new program design, processes, client expectations and partner relationships; makes recommendations for improvements;
and develops best practices for disability and leave operational processes.
Serves as subject matter expert responsible for the training of technical processes and requirements; leads training initiatives for colleagues, supervisors / managers and clients as needed.
Leads projects focused on large process, procedural and / or compliance changes / updates; communicates changes / updates to field offices, IT, Legal and other applicable business units regarding regulatory requirements and changes.
Plays key role in maintaining client relationships; assists in new business productions; and represents Company with specified industry groups.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
Provides support, guidance, leadership and motivation to promote maximum performance.
Education & Licensing
Bachelor's degree from an accredited college or university or equivalent preferred.
Ten (10) years of claims management, managed care and / or other related experience or equivalent combination of education and experience required to include three (3) years in a supervisory capacity in the specified field.
Skills & Knowledge
In depth knowledge of claims management, managed care and / or absence management processes and procedures
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
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