Mgr, Claims Operations; Hybrid - Windsor, CT

About the Role

This role is hybrid, requiring at least 60% in-office work at the Windsor, CT location and the remainder remote from within the continental US.

Principal Duties & Responsibilities

• Manages the daily operations of the Claims business unit; manages employees and operations at the functional level; gathers and analyzes data and reports pertaining to overall operations and completes reports summarizing activities and trends; assists in strategic and tactical operational plans to ensure achievement of company and departmental goals; performs independent review of problem situations; develops solutions and implements actions to resolve problems and ensure customer satisfaction; reviews processes and procedures to streamline activities to enhance service turnaround time, productivity, and quality; coordinates overall workflow and ensures that workflow processes facilitate effective and efficient use of corporate resources and enhance customer satisfaction
• Directs efforts to implement risk management and quality improvement initiatives; facilitates calibration sessions; uses methods such as work process studies, statistical analysis, and assessments of production area performance to establish adherence to quality standards/scorecards; remains abreast of industry trends and technology changes; incorporates best practices in the development of quality standards, policies, programs, and system changes for the department; ensures that claims are processed according to appropriate risk selection principles
• Coordinates and monitors training efforts to ensure that necessary education tools are provided to employees; identifies and communicates training needs and schedules with training department; projects staffing requirements for the business unit; guides supervisors in coaching and counseling employees; coordinates employee development and incentive initiatives
• Identifies, analyzes, and monitors business technology requirements and enhancement possibilities; recommends viable technological solutions, modifications, and applications; prepares recommendations for implementation of initiatives; takes a leadership role in managing assigned initiatives; participates in and supports companywide initiatives through Quality Circles, Focus Groups, or other project initiatives
• Monitors and controls operating expenses to ensure that corporate/divisional financial goals are met; provides input into the annual business unit budget; reviews legal files and coordinates with counsel to prepare for depositions and court hearings
• Performs other related duties as required

Requirements

• Bachelor's Degree in Health Administration, Business, or a related field
• 6 years of job-related work experience
• 4 years in a leadership/senior/supervisory capacity
• Or an equivalent combination of education and experience

Preferred Qualifications

• Claims administration, or experience in a related field or industry
• Insurance or other industry designations

Skills

• Broad knowledge of production management concepts, operating principles, and operational management methodology applicable to claims processing; high degree of skill in applying this knowledge to the analysis and resolution of very complex or sensitive claims operational issues; ability to apply new developments and methodologies to direct the improvement in efficiencies
• Broad knowledge of federal, state, and local regulatory and industry requirements, standard concepts, practices, and procedures as they relate to the insurance industry and claims processing
• Knowledge of budgeting and expense control to plan, implement, and maximize expenditure of funds while maintaining and improving quality standards
• Knowledge of employee relations to conduct and deal with employee issues in a proactive manner
• Strong personal computer skills with experience in Windows-based software; experience using Microsoft Outlook or a similar e-mail system software
• Excellent presentation, oral, written, and interpersonal communications skills to effectively interact with senior management, and internal and external business contacts

Pay

$90,000 - $120,000

Benefits

• Medical, dental, and vision coverage
• Prescription drug coverage
• Health care flexible spending and dependent care flexible spending
• Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no cost to employee)
• 401(k) plans
• Annual bonuses
• Opportunity to purchase company stock
• 11 paid holidays annually
• Up to 20 days PTO for any reason
• State-mandated sick leave where applicable (Washington employees accrue 1-hour sick leave for every 40 hours worked)
• Other leaves of absence, if eligible, including adoption and parental leave