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Claims Supervisor / Expert

The Claims Supervisor / Expert is a senior-level professional responsible for managing and overseeing complex and high-value claims processes across various insurance or organizational contexts. This role involves coordinating claims resolution strategies, ensuring compliance with pre-determined legal and regulatory standards, mentoring junior personnel, and implementing process improvements in an attempt to enhance operational efficiency. The Claims Supervisor / Expert acts as a key contributor to risk mitigation and customer satisfaction, requiring both strategic insight and exceptional communication skills.

Class Code:

PCA03P

Job Grade:

SGS08

Special Job Requirements:

Typical Functions:

The assignment of supervisory duties is determined by the hiring agency’s operational needs. Non-supervisory roles will serve as senior technical experts. Oversee and manage the coordination of complex claims, ensuring accurate and efficient processing from initial submission to resolution. Collaborate with internal and external personnel, including legal representatives, adjusters, and claimants, to resolve disputes and ensure claims compliance with policy terms. Lead initiatives to detect and mitigate fraud or errors, employing advanced investigative techniques. Design and implement advanced claims coordination workflows and process improvements to optimize operational efficiency and accuracy. Monitor industry regulations, trends, and legal standards to maintain compliance and align organizational practices with the latest requirements. Provide training and mentorship to junior claims coordinators, fostering professional growth and best practices. Create detailed claims reports and analyses, providing strategic insights to senior management and supporting data-driven decision-making. Act as a subject matter expert for claims coordination issues and escalate high-stakes cases as necessary.

Knowledge, Abilities, and Skills:

Advanced analytical, organizational, and problem-solving capabilities. Exceptional communication and negotiation skills for interacting with claimants and a variety of assorted personnel. In-depth knowledge of claims management software and systems. Strong understanding of relevant insurance policies, laws, and regulations. Leadership abilities and experience in managing teams or projects. A proactive approach to adapting to industry changes and challenges.

Minimum Qualifications:

Bachelor’s degree in business administration, insurance, risk management, healthcare administration, or a related field. Minimum of 6 years of experience in claims coordination, claims management, customer service, or related fields. Proven expertise in handling complex claims and leading process improvement projects. Professional certifications such as Certified Claims Professional (CCP), Chartered Property Casualty Underwriter (CPCU), or equivalent may be required. Satisfaction of the minimum qualifications, including years of experience and service, does not entitle employees to automatic progression within the job series. Promotion to the next classification level is at the discretion of the department and the Office of Personnel Management, taking into consideration the employee’s demonstrated skills, competencies, performance, workload responsibilities, and organizational needs.

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
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