Claims Manager

ABOUT THE COMPANY At MEM, we’ve created a casual, values-driven work culture that’s making a positive impact on the way people live and work. We offer a hybrid work model, with positions to accommodate the changing needs of today’s employees. Our team enjoys a variety of different work environments, which allows for more flexibility, less time spent commuting, and greater ability to address personal and family needs. This is a place where you can grow with confidence – because that’s what safety and success really mean to us.   MEM is headquartered in Columbia, MO, and our virtual team serves our policyholders and partners from across the U.S.     JOB PURPOSE            In a dynamic role reporting to the Claims Operations Manager, this Claims Manager role is pivotal in fostering a culture of continuous learning and development. This role centers around empowering and guiding a dedicated, remote team of claims professionals through transformative coaching and mentorship. As a key architect of skills enhancement, the Claims Manager will be instrumental in identifying and cultivating talent, nurturing professional growth, and driving process improvement initiatives. This includes overseeing the daily operations related to managing, investigating, and resolving workers’ compensation claims, with a strong emphasis on optimizing team performance and delivering exceptional results through strategic people management.   RESPONSIBILITIES   Claims and Risk Management ·         Monitor and approve total settlement, reserve & payment authority of their respective claims team.  ·         Provide management support for Claim Representative activities on to ensure key investigative elements are addressed and that all aspects of loss dollars are managed to the best results possible. ·         Approve reserves or payments above the authority of staff members, but within own authority.  When over own authority, provides proper documentation to support the reserve or payment recommendation for approval. ·         Approve or decline all denial recommendations, safety/drug/alcohol penalties and trials.  Ensure any Appeal recommendations have advance approval. ·         Approve Risk Alerts, Serious Claim Notices, Late Pay Codes and appropriate Finance forms. ·         Actively participate in all relevant POA sessions for their respective team, including extending authority when appropriate and providing input into action plan discussions.  The leader is expected to provide guidance and relevant support in the POA sessions.    Leadership and Direction Communicate the local action plan; explain how this relates to the function's strategy and action plan and to the broader organization's mission and vision; motivate people to achieve local business goals.   Insurance Claims Administration Review and analyze complex insurance claims in line with the organization's standard claims procedures and customer service standards. Initiate investigations and engage independent loss adjusters and/or subject-matter experts where appropriate. Authorize claims within delegated authority and refer unresolved issues or disputes to line manager.   Performance Management Monitor team performance incongruence with department metrics and key performance indicators to drive action and results. Manage and report on the performance of the department; set appropriate performance objectives for direct reports and departmental teams and hold individuals accountable for achieving them; take appropriate corrective action where necessary to ensure the achievement of team/individual objectives   Team Management Manage a team so that team members are supported and enabled to deliver their roles according to expected standards. Includes leading in the areas of recruitment and performance management, coaching team members, and identifying development needs.   Compliance Identify shortcomings in compliance processes, systems, and procedures, and suggest and implement appropriate improvements. Work is focused on an assigned unit or discipline.   Organizational Capability Building Provide coaching to team members to develop their skills.   Processes Automation Analyze business processes and workflows to identify routine and repetitive tasks and opportunities for increasing efficiency.   Continuous Improvement Review existing operations in own area of work and implement innovation processes to generate new ideas and ensure continuous improvements are delivered.   Coaching Conduct routine coaching operations, including minor skills gap analysis and preliminary feedback sessions to employees.   Caseload Management Work regularly with peers to help manage the claims caseload based on complexity and risk to ensure the team can operate efficiently and ensure high quality service outcomes   Regulatory and Compliance Management Ensure appropriate processes and controls are followed and executed in compliance with legal and regulatory requirements   Budgeting Track budgets and related to operational areas and report variances to senior members of the Claims leadership team.   Solutions Analysis Analyze specific problems and issues to find the best solutions. Solutions could be technical or professional in nature   TOOLS                 Word; Excel; PowerPoint   EDUCATION              Bachelor's Degree preferred but will consider a combination of education with experience.   EXPERIENCE            General Experience 6-10 years of claim experience in workers’ compensation is required.   Managerial Experience 1-3 years' experience of supervising and directing people and other resources to achieve specific end results