Manager, Operational Excellence,Claims

The Manager, Claims Operational Excellence role plays a key role in the performance of the Claims Department at Gore Mutual. This role exists to lead and oversee Learning & Development, Quality Assurance Programs, Customer Experience programs, and Claims Communication. The objectives are to drive continuous improvement, ensure high-quality service delivery, and enhance customer satisfaction. The expected end results include a well-trained and efficient claims team, improved claims processes, and a superior customer experience, all contributing to the company's overall success.

What will you do?

Leading Learning & Development Initiatives

• Guiding the team in designing and implementing training programs for the claims department.
• Overseeing the assessment of training needs and development of relevant content.
• Leading the monitoring and evaluation of the effectiveness of training programs.

Overseeing Quality Assurance Programs

• Directing the team in developing and maintaining quality assurance standards.
• Ensuring adherence to regulations, privacy, and compliance standards.
• Supervising regular audits and reviews of claims processes.
• Leading the identification of areas for improvement and implementation of corrective actions.

Enhancing Customer Experience Programs

• Steering the team in developing strategies to improve customer satisfaction.
• Overseeing the monitoring of customer feedback and identification of trends.
• Leading the implementation of initiatives to address customer concerns and improve service delivery.

Overseeing Workforce Management

• Leading and providing direction on creating and optimizing the workforce management strategy for the claims department.
• Analysing volumes, trends, forecasting and determining optimal headcount requirements for the claims department in all functions and roles.
• Oversee compliance with scheduling, phone SLAs and vacation and time off practices.
• Optimize the use of resources including flexibility of resources based on seasonality, hiring plan, need for coverage focusing on productivity and customer service excellence.
• Partner and collaborate with Operations WFM resources on enterprise-wide strategy and approach.

Managing Claims Communication

• Ensuring the team maintains clear and consistent communication within the claims department.
• Overseeing the development of communication materials and guidelines.
• Facilitating effective communication between the claims team and other departments.

Driving Continuous Improvement

Leading the team in identifying opportunities for process improvements. Monitoring performance metrics and adjusting strategies as needed.

What will you need to succeed in this role?

• Bachelor's degree in relevant field and CIP designation desirable.
• 5-7 years of experience in the insurance industry, with a focus on claims management.
• Leadership Experience: Proven experience in leading and managing teams.
• Project Management: Experience in managing cross-functional projects and initiatives.
• Analytical Skills: Strong ability to analyze data and metrics to drive performance improvements.
• Communication Skills: Excellent verbal and written communication skills for effective interaction with internal and external stakeholders.
• Problem-Solving Skills: Ability to identify issues and implement effective solutions.
• Technical Skills: Proficiency in using claims management software and data analytics tools.
• Customer Focus: Strong commitment to enhancing customer experience and satisfaction.
• Regulatory Knowledge: Understanding of industry regulations, privacy, and compliance standards.

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