Claims Team Lead , Auto | Remote

PRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and technical staff for liability claims for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. PIP experience preferred.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• 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.

QUALIFICATIONS

Education & Licensing: Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.

Experience: Six (6) years of claims management experience related to professional liability claims or equivalent combination of education and experience required to include two (2) years of claims supervisor experience.

Work environment: When applicable and appropriate, consideration will be given to reasonable accommodation.
Physical: Computer keyboarding, travel as required
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.