Provider Services Claims Team Lead - SGS

Job Summary :

The is responsible for the smooth day-to-day operations of the Claims Unit, including the intake and processing of claims and supporting the Federal Agency and employees in the claims process. They are responsible for ensuring the unit functions to its highest level by leading the team to attain unit goals, modeling peak claims management performance, and training the unit in best practices. The Claims Supervisor supervises the Claims Specialists.

Essential Functions Duties and Responsibilities

Supervision

Manage the team of Claims Specialists.

Oversee, and modify as needed, claims operations to ensure timely, effective, and efficient services to customers.

Manage individual caseload and customer service responsibilities as assigned, and modify as needed to optimize unit performance.

Provide guidance to Claims Specialists in the application of policies and procedures to daily operations

Become an expert in expertise to the operations of the Claims Unit; serve as the technical lead for FECA-related questions.

Hold one-on-one meetings with Claims Specialists to discuss the status of work, next steps, and feedback on job performance.

Hold bi-weekly Claims Teams Meetings to communicate changes, educate the team, and discuss issues encountered by team members.

Serve as the first line of escalation for a Claims Specialist requiring help with a claim, and provide mentorship in claims management techniques

Develop and maintain a coverage plan for all claims activities, including call center, during normal and high-volume work periods and in accordance with contract requirements.

Organize and ensure employee performance evaluations are conducted according to company policy.

Conduct Quality Assurance activities and ensure team members function to standard. Develop and conduct corrective actions, including training or coaching when a deficiency is identified.

Review, update and create Standard Operating Procedures, Work Instructions, and Job Aids.

Identify and escalate areas of concern or opportunity to the Claims Manager.

Participate in development of training materials and training plan; train Claims Team to maintain a high level of customer service.

Independently identify and develop responses to risks or issues.

Provide technical advice and assistance to agency managers, supervisors, and claimants on the program processes, issues, or concerns.

Review medical and administrative documentation for accuracy and, if an appropriate challenge or controvert claims.

Provide other claims management support as necessary. Overall

Function as an effective team leader; support the team by pitching in at any level and effectively working across the organization to meet the needs of the business.

Takes ownership of personal actions and outcomes; encourages and empowers others to do the same.

Embrace change; maintain an open mind and remain flexible and adaptable in the face of ambiguity and change

Ability to work independently, multitask, and adjust priorities

Proactively seek opportunities to increase knowledge, skills, and abilities

Ability to work well in a team environment, with a moderate degree of supervision, to handle a heavy workload, to prioritize work for self and staff, and to meet assigned deadlines

Strong people and organizational skills, and attention to detail

Must be able to keep client matters strictly confidential.

May perform other duties, as needed, to meet the needs of the business

Requirements :

MUST BE A US CITIZEN.

Education Bachelor's degree.

Four years of additional experience may be substituted for a Bachelor's degree.

We will require someone with both call center experience and medical claim processing background.

Must have computer experience with Microsoft office / word / excel experience. (Preferred to have hard wired internet and not just WIFI for connectivity) The candidate should have leadership experience and also working remotely.

Experience

A minimum of four years experience in workers' compensation, claims administration, utilization review, or related field.

Minimum of four years supervisory experience, including performing the job functions listed above.

Communication Skills

Excellent organizational and skills.

Superior customer service skills, working proactively and collaboratively with clients and co-workers.

Strong team player; ability to partner with external and internal clients and other cross-functional departments.

Strong writing and communication skills.

Must write succinctly and clearly.

Must be able to explain complex concepts to staff in a training environment.

Reasoning Ability

Able to deal with concepts and variables.

Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.

Supervisory Responsibilities

Provide direct supervision, coaching, and guidance to the Claims Specialists.

Monitor and motivate the staff to reach and exceed unit goals.

Recruit, hire, and retain Claims Specialists.

Provide timely direct feedback to staff through scheduled guidance / coaching sessions and mid-year / annual evaluations. This includes active coaching and engaging employees to enhance their performance and commitment. Assist employees to develop skills needed to achieve optimal performance and strong performance in their role.

Actively resolve employee conflict by utilizing improvement efforts, multi-disciplinary strategies, problem-solving skills, and conflict management. Make timely decisions based on the evaluation of outcomes and communicate the results effectively so that the employee understands the reason behind the decision.

Effectively counsel and coach employees on performance and behavioral improvements. Understand and appropriately apply employee disciplinary procedures with appropriate documentation. Coordinate terminations with HR.

Monitor employee attendance and approve timesheets of direct reports. Authorize vacations and personal days in accordance with staffing needs.

Has authority to provide suggestions and recommendations as to the hiring, firing, advancement, promotion, or any other change in employment status.

Other Skills and Abilities, Qualifications

Thorough working knowledge of claims practices and procedures. Proficiency in Microsoft Office

Proficient Computer Software (SW) Skills :

o Personal computer equipment

o Overall Business SW (e.g. MS-Office Suite )

Strong ability to organize and coordinate projects.

Strong oral and written communication abilities.

United States Citizenship

Must be able to obtain and maintain confidential-level security clearance(s) as required

Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services.

Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.