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Director, Claims (Remote)

Remote: 
Full Remote
Contract: 
Experience: 
Expert & Leadership (>10 years)
Work from: 

Offer summary

Qualifications:

Bachelor's Degree with 8+ years experience, High School Diploma or GED with 10+ years experience.

Key responsabilities:

  • Oversee claims processing organization and ensure timely processing.
  • Develop policies for accurate claims adjudication and drive strategic direction.
  • Conduct settlement discussions and manage cross-functional projects.
  • Analyze savings and implement process improvement initiatives.
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Trustmark Health, Sport, Wellness & Fitness Large https://www.trustmarkbenefits.com/

Job description

Trustmark’s mission is to improve wellbeing – for everyone. It is a mission grounded in a belief in equality and born from our caring culture. It is a culture we can only realize by building trust. Trust established by ensuring associates feel respected, valued and heard. At Trustmark, you’ll work collaboratively to transform lives and help people, communities and businesses thrive. Flourish in a culture of diversity and inclusion where appreciation, mutual respect and trust are constants, not just for our customers but for ourselves. At Trustmark, we have a commitment to welcoming people, no matter their background, identity or experience, to a workplace where they feel safe being their whole, authentic selves. A workplace made up of diverse, empowered individuals that allows ideas to thrive and enables us to bring the best to our colleagues, clients and communities.

Responsible for overseeing a claims processing organization. Ensures claims are processed in a timely manner in accordance and compliant with government regulations. Develops claims adjudication policies and procedures that maximize the accuracy of claims payments. Evaluates claims activities to assess cost-effectiveness and implement process improvement initiatives.

  • Drives strategic direction of the entire claims function, including innovation, and ensuring the highest standards of service and compliance.
  • Establishes and monitors key performance indicators and metrics to measure departmental performance. Identifies trends, develops and implements plans to improve results and processes while delivering excellence in cost and service.
  • Conducts settlement discussions, or mediations when appropriate as well as travel as necessary to meet and/or negotiate with claimants and legal representatives. Provides sign-off approval of highly complex or high-dollar claims.
  • Fosters a culture of continuous improvement and innovation within the claims organization.
  • Works with Claims Compliance Liaison to ensure correct interpretation of new statutory and federal regulations are properly inserted into claims workflow. Reviews audits reports to ensure compliance and reports to Leadership. Makes changes to improve quality.
  • Oversees department’s support projects. Manages multiple cross-functional projects by assigning resources, working on timelines and implementing schedules to complete project timeline.
  • Analyzes savings and tracks post implementation results of change in product, process, or projects.

Minimum Requirements

  • Bachelor's Degree with 8+ years of related experience OR High School Diploma or GED with 10+ years related experience.

Brand: Trustmark

Come join a team at Trustmark that will not only utilize your current skills but will enhance them as well. Trustmark benefits include health/dental/vision, life insurance, FSA and HSA, 401(k) plan, Employee Assistant Program, Back-up Care for Children, Adults and Elders and many health and wellness initiatives. We also offer a Wellness program that enables employees to participate in health initiatives to reduce their insurance premiums.

For the fourth consecutive year we were selected as a Top Workplace by the Chicago Tribune. The award is based exclusively on Trustmark associate responses to an anonymous survey. The survey measured 15 key drivers of engaged cultures that are critical to the success of an organization.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, veteran or disability.

Required profile

Experience

Level of experience: Expert & Leadership (>10 years)
Industry :
Health, Sport, Wellness & Fitness
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Leadership
  • Strategic Planning
  • Analytical Thinking
  • Verbal Communication Skills

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