What are the responsibilities and job description for the Provider Services Claims Team Lead position at Synectics Inc?
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.
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.
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.
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.
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.
Requirements:
Education Bachelor's degree.
Four years of additional experience may be substituted for a Bachelor's degree.
Both call center experience and medical claim processing background.
Must have computer experience with Microsoft office / word/ excel experience.
Leadership experience and also working remotely.
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
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.
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.
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.
Thorough working knowledge of claims practices and procedures.
Proficient Computer Software (SW) Skills: Personal computer equipment & overall Business SW (e.g. MS-Office Suite)
Strong ability to organize and coordinate projects.
Benefits:
Healthcare Insurance: Synectics offers eligible employees and their dependents healthcare coverage through BlueCross BlueShield of Illinois. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics. Premiums are subsidized by Synectics.
Dental Insurance: Synectics offers eligible employees and their dependents a dental plan through MetLife. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.
Vision Insurance: Synectics offers eligible employees vision insurance through VSP. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.401(k) Plan: The Synectics Inc. Investment Savings Retirement Plan. Synectics offers all employees who are 21 years of age or older the opportunity to invest in the 401(k) Plan on the first enrollment date that is at least 30 days after employment begins. Enrollment dates are each January 1st, April 1st, July 1st, and October 1st.
Technical Certification Bonus: Synectics is pleased to award its employees a bonus of up to $500 for an approved professional certification. In determining the bonus amount, Synectics will consider the cost of the test(s) for any certification relating to your current position, achieved during your employment with us. Only one Certification Bonus per calendar year may be awarded per employee. Only current, active employees will be eligible to receive this bonus. It will be awarded 90 days after the Synectics office has received documentation confirming the successful completion of the certification.
Synectics is an equal opportunity employer.
