CLAIMS REVIEW SUPERVISOR/EXPERT
State of Arkansas · Little Rock, AR · 3 mo ago
Finance$52k–$77k/yrFull-time
Primary Responsibilities
- Conduct comprehensive reviews of complex, high-value, or specialized claims to determine eligibility and validity.
- Provide guidance and resolution for escalated claims that require expert analysis and decision-making.
- Collaborate with internal personnel, external personnel, and legal teams in an attempt to resolve disputes and ensure compliance with regulations.
- Design and implement process improvements in an attempt to optimize claims handling efficiency and accuracy.
- Lead or contribute to fraud detection initiatives by identifying patterns and assessing claims for potential fraudulent activity.
- Serve as a subject matter expert and mentor for junior claims analysts, providing training, support, and development opportunities.
- Stay abreast of industry trends, regulatory changes, and best practices to ensure claims processes align with current standards.
- Generate detailed reports and present data-driven insights to senior management to guide policy adjustments or operational decisions.
Knowledge And Skills
- Advanced analytical skills and attention to detail.
- Strong leadership and mentoring abilities.
- Proficient in claims management systems and tools.
- Excellent written and verbal communication skills.
- Sound knowledge of relevant legal and regulatory frameworks.
Minimum Qualifications
- Bachelor’s degree in a relevant field, such as business administration, finance, insurance, risk management, or healthcare administration.
- Minimum of 4 years of experience in claims review, analysis, or a related field within the insurance or financial services industry.
- Demonstrated expertise in handling complex claims and a proven track record of high-level decision-making.
- Experience in a specialized claims sector, such as healthcare, property and casualty, or workers’ compensation may be required.
- Professional certifications such as Associate in Claims (AIC), Certified Professional Claims Analyst (CPCA), or Chartered Property Casualty Underwriter (CPCU) may be required.