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Claims Team Lead - Consumer

  • Location: Seven Hills, 44131-6922
  • Salary: 24.64
  • Job Type:Contract

Posted 19 days ago

Long term contract Opportunity!
 
Title: Claims Team Lead
Location: Seven Hills, OH 44131
Term: 12 Months Contract


Day-to-Day Responsibilities:
 
  • Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit
  • Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office
  • Provides technical/jurisdictional direction to examiner reports on claims adjudication
  • Compiles reviews and analyzes management reports and takes appropriate action
  • Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards
  • Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal
  • Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner
  • Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client
  • Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client
  • Assures that direct reports are properly licensed in the jurisdictions serviced
  • Ensures claims files are coded correctly and adequate documentation is made by claims examiners
  • Performs other duties as assigned
  • Supports the organization's quality program(s)

Is this a good fit? (Requirements):
 
  • 6 years of claims experience or equivalent combination of education and experience required
  • 2 years claims supervisor experience
  • Thorough knowledge of claims management processes and procedures for multiple product lines
  • PC literate, including Microsoft Office products
  • Leadership/management/motivational skills
  • Analytical and interpretive skills
  • Heavier claims experience
  • Strong organizational skills
  • Excellent interpersonal skills
  • Excellent negotiation skills
  • Ability to work in a team environment
  • Ability to meet or exceed Performance Competencies
  • Licenses as required
  • Professional certifications as applicable to line of business preferred
  • Bachelor's degree from an accredited college or university preferred

If this sounds like the perfect fit, Apply Today!

 

Candidates will be responsible for following the client's COVID-19 protocols. Please refer to your MATRIX representative for specifics.

About Us

At MATRIX, we expertly match talented professionals with job opportunities to elevate careers. Since 1983, we have placed thousands of professionals at innovative clients across every industry ranging from small startups to Fortune 50 companies. It’s why we’re consistently in the top 25 of all U.S. IT staffing firms and why our consultants rate us well above the industry average, earning us ClearlyRated's Best of Staffing awards year after year. People come to us for a job, and stay with us because of our top-notch consultant care.

MATRIX is and Equal Employment Opportunity employer and provides reasonable accommodations for qualified individuals.  Supporting medical or religious documentation will be required where applicable. If you are a qualified individual with a disability, you may request a reasonable accommodation under the American Disability Act (ADA) by emailing MATRIX_HR@MatrixRes.com. To ensure a quick response to your request, please use the words “Accommodation request” as the subject line of your email.