What are the responsibilities and job description for the Claim Service Manager - Remote or Hybrid position at A-G Specialty Insurance, LLC?

Job Description

The Claim Service Manager is responsible for planning, organizing, directing, and controlling a Claim Service Team who process Accident & Health insurance claims. This role includes working as an autonomous claim examiner, along with managing a team of direct reports.

Essential Duties & Functions

Manager

Interview, hire, train, and develop Claim Service Team
Ensure legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations and enforce equally and fairly on team
Analyze workload index and delegate responsibilities as needed
Review monthly claim audits along with performance management that includes goal setting, feedback, disciplinary action, and rewards
Developing performance metrics, goals, and best practices for both individuals and team
Establish and maintain constructive relationships with customers, clients, providers, and other key stakeholders
Monitor and provide feedback to Claim Management Leadership on the company’s proprietary claims system performance and areas of opportunity for system enhancements
Create a workplace culture that is consistent with the company’s mission, vision, and values
Assist in resolving complex claim and services issues

Claim Services

Demonstrate fundamentally sound claim handling by achieving compliance in the areas of investigation, coverage and processing of claims

Timely and appropriately communicate with the claimant and client, as well as internally

Establish proof of loss by reviewing medical documentation; assembling additional information as required from outside sources; including claimant, client, provider, and other insurance companies

Calculates and pays benefits due; approves and makes timely claim payments and adjustments

Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients

Recognize and properly address coverage issues, potential fraud, and subrogation

Ensure claim files are properly documented through internal notes and correspondence logs, and claim coding is correct

Refer cases as needed to Vice President of Claims, Insurance Carrier, Program Management, and other appropriate parties internally and externally.

Job Skills

Team Player

Excellent verbal and written communication

Behavior flexibility, ability to adapt management style

Advanced critical thinking and problem-solving skills

Strong decision-making ability and sound judgement

Knowledge and understanding of Department of Insurance regulations

Exhibits leadership qualities and forward-thinking mindset

Ability to obtain and maintain Insurance Adjuster License

Job 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 accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required / Preferred Education and Experience

Required Education : Bachelor’s Degree or comparable experience

Preferred Experience : 3-5 years insurance experience

Preferred Licensure : Accident & Health Adjuster License

Position Type and Expected Hours of Work

This is a full-time remote or hybrid position. Days and hours of work are Monday through Friday, 8 : 30 a.m. to 5 p.m. EST. The schedule for this role can be contingent upon Supervisor and Human Resources approval. Some evening and weekend work may be required.

Travel

Limited travel would be encouraged for trainings or team meetings. This would be discussed ahead of time and agreed upon between both Supervisor and employee.

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Claim Service Manager - Remote or Hybrid

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