Workforce Absence Team Lead

PRIMARY PURPOSE

To supervise the operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, 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 within the teams including frequent diaries on complex or high exposure claims.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Supervises multiple teams of examiners and/or several 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.
• 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.
• Affirms that direct reports are properly licensed in the jurisdictions serviced.
• Maintains claims files are coded correctly and adequate documentation is made by claims examiners.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

• Supports the organization's quality program(s).
• Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
• Interviews, hires, and establishes colleague performance development plans; conducts colleague performance discussions.
• Provides support, guidance, leadership and motivation to promote maximum performance.

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 experience or equivalent combination of education and experience required. Two (2) years of claims supervisory experience preferred.
• Skills & Knowledge: Thorough knowledge of claims management procedures and processes for disability. Excellent oral and written communication, including presentation skills. PC literate, including Microsoft Office products. Leadership/management/motivational skills. Analytical and interpretive skills. Strong organizational skills. Excellent interpersonal skills. Excellent negotiation skills. Ability to work in a team environment. Ability to meet or exceed Performance Competencies.