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Claims Manager
The Claims Manager oversees and leads the insurance claims process within an agency or organization, ensuring all claims are handled efficiently, accurately, and in compliance with pre-determined agency policies and regulatory standards. This role involves supervising claims personnel, implementing strategies for process improvements, and resolving complex claims. The Claims Manager plays a pivotal role in reducing organizational risk, maintaining customer satisfaction, and fostering team development.
Class Code:
PCA02C
Job Grade:
SGS09
Special Job Requirements:
Typical Functions:
Oversee the entire claims process, including the review, analysis, and resolution of claims across multiple areas of coverage. Supervise and provide guidance to claims analysts, coordinators, and other team members, fostering professional growth and maintaining high performance standards. Develop and implement strategies to enhance claims management efficiency and accuracy. Collaborate with internal personnel, external personnel, and legal teams to resolve disputes and manage escalated claims. Ensure compliance with local, state, and federal laws, as well as industry regulations and agency policies. Monitor claims data and generate reports to provide insights for management and drive informed decision-making. Lead initiatives to identify and mitigate fraud or errors within the claims process. Establish and maintain strong relationships with claimants, insurers, and a variety of assorted. Stay updated on industry trends and regulatory changes to proactively adapt claims practices and policies.
Knowledge, Abilities, and Skills:
Strong leadership and managerial abilities. Advanced analytical skills for interpreting claims data and resolving disputes. Excellent communication and negotiation skills for liaising with a variety of assorted personnel. Proficiency in claims management software and tools. In-depth understanding of insurance policies, laws, and industry regulations. Ability to handle high-pressure situations and adapt to changing priorities with a solution-focused mindset.
Minimum Qualifications:
Bachelor’s degree in business administration, insurance, finance, risk management, or a related field. Minimum of 8 years of experience in claims coordination, claims management, customer service, or related fields. Proven track record of successfully supervising teams and managing complex claims processes. Experience in specialized claims areas (e.g., healthcare, property and casualty, or workers’ compensation) may be required. Professional certifications such as Certified Claims Professional (CCP), Chartered Property Casualty Underwriter (CPCU), Associate in Claims (AIC), or equivalent may be required.
Required Certificates:
N/A OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.
Exempt:
E