出海雷达

西部地区经理,索赔(远程 - 居住地在西部州)

WC Regional Manager, Claims (Remote - Residency in Western States)

其他限定地区(需当地身份)
公司Blue Cross Blue Shield of Michigan
薪资$100,000 - $158,350/年
工作地点United States
地域资格限定地区(需当地身份)
时区要求日间重叠约 9 小时,基本正常作息
用工类型Full Time
发布时间11 天前
数据来源Himalayas
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注意地域限制:该职位明确限定在 United States 招聘。如果你是位于中国大陆的求职者,通常需要当地工作身份才能投递,或需与雇主确认是否接受独立合同(Contractor)形式合作。

职位描述
根据理赔裁决和福利分配的要求,为区域工伤赔偿理赔组织提供领导。负责理赔运营的整体表现,包括理赔质量、客户体验、团队发展、财务责任、合规性以及运营效率。带领理赔专业人员和支持员工实现组织目标,同时促进问责制、持续改进、协作和服务卓越的文化。

主要职责和工作内容包括以下内容。其他职责可能被指派。

  • 管理单一业务线的工伤赔偿理赔专业人员和支持员工。
  • 领导理赔团队,支持部门在成本控制、案件文件处理、客户服务和质量方面的计划和策略。
  • 持续监控工作流程,以最大化准确性和效率。保持可接受的服务水平和客户满意度及留存率。
  • 有效管理质量审查流程。
  • 制定部门目标、目的、流程、程序和系统。
  • 关注工伤赔偿法规、判例法和康复进展的变化。
  • 识别团队人员需求,并采取必要措施确保适当的服务水平。
  • 指导员工并为其制定职业发展路径,提供成长机会。
  • 参与年度部门预算的制定,监控预算并识别预算差异。研究差异原因并提出建议。
  • 根据需要参与特殊项目并担任委员会成员。

教育和经验
相关教育和经验的组合可替代学位。

  • 相关领域的学士学位。
  • 在理赔环境中具有7年经验,具备展示出的技术经验,提供必要的知识、技能和能力。
  • 需要3年的理赔监督或领导经验。
  • 具有多司法管辖区的工伤赔偿理赔管理经验者优先。
  • 具备双语能力者优先。

资格要求
成功完成本职位的个人必须能够满意地完成每一项关键职责。以下列出的要求代表了所需的知识、技能和/或能力。可根据需要为残疾人提供合理的工作调整。

查看英文原文

SUMMARY
Provides leadership for a regional workers' compensation claims organization in accordance with claims adjudication and benefit allocation. Responsible for the overall performance of claims operations, including claim quality, customer experience, workforce development, financial stewardship, regulatory compliance, and operational effectiveness. Leads claim professionals, and support staff in achieving organizational goals while promoting a culture of accountability, continuous improvement, collaboration, and service excellence.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

  • Manages monoline workers' compensation unit of claim professionals and support staff.
  • Leads claim team in support of department initiatives and strategies in cost containment, case file handling, customer service and quality.
  • Consistently monitors workflows to maximize accuracy and efficiency. Maintains an acceptable level of service and customer satisfaction and retention.
  • Effectively manages the quality review process.
  • Develops unit goals, objectives, processes, procedures and systems.
  • Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation advancements.
  • Identifies team staffing needs and takes necessary measures to ensure appropriate levels of service.
  • Mentors employees and develops career paths with growth opportunities.
  • Participates in development of annual departmental budget, monitors budget and identifies budget discrepancies. Researches cause of discrepancies and makes recommendations.
  • Participates in special projects and serves on committees as needed.

EDUCATION AND EXPERIENCE
Relevant combination of education and experience may be considered in lieu of degree.

  • Bachelor’s degree in a related field.
  • Seven (7) years of experience in a claim environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities.
  • Three (3) years of supervisory or leadership experience in claims required.
  • Previous workers’ compensation claim management with multi-jurisdictional experience preferred.
  • Bilingual skills preferred.

QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
OTHER SKILLS AND ABILITIES

  • Knowledge of team building and employee motivation theories with the ability to effectively manage multi-functional employee teams.
  • Demonstrated leadership abilities.
  • Knowledge of laws, regulations and compliance requirements related to workers’ compensation insurance.
  • Demonstrated technical knowledge of insurance administration, claims management or relevant insurance expertise.
  • Ability to work with and empower others on a collaborative basis to ensure success of unit team.
  • Excellent oral and written communication skills.
  • Knowledge of insurance and underwriting techniques, agency and policyholder needs.
  • Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
  • Ability to establish workflows, manage multiple projects and meet necessary deadlines.
  • Ability and proficiency in the use of computers and company standard software specific to position.

SUPERVISORY RESPONSIBILITIES
Directly supervises a varied number of employees in the designated department(s). Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
ADDITIONAL INFORMATION
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.
WORKING CONDITIONS
Work is performed in a virtual office with no unusual hazards. Travel is required, with some occasional overnight stays. Must possess a valid driver's license with a record that meets corporate standards. Must be able to meet general physical requirements that would allow the ability to view and participate in account operations which may include climbing ladders and scaffolding, work in confined spaces, and or other similar situations.
Pay Range - Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $100,000 and $158,350.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.
#CWU
Originally posted on Himalayas

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