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Showing posts with label claims. Show all posts
Showing posts with label claims. Show all posts
Complex Claims Director - Workers Compensation - Liberty Mutual - Elmsford, NY
Advance your career at Liberty Mutual Insurance - A Fortune 100 Company!
Seeking a
Complex Director
manager to join our Workers Compensation team, managing a team of employees. The ideal candidate will bring leadership skills and a superior ability to develop, coach and mentor.
Supervises the day-to-day claims activities for the unit by establishing priorities, scheduling and assigning work, adjusting schedules when necessary to meet completion dates, and assisting others with resolving complex problems while ensuring adherence to service and quality standards.
Analyzes claims files prepared by claims staff, approves payments, and grants authority for settlements when appropriate.
Acts as a technical expert and provides direction in various areas, such as compensability determination, investigation, coverage interpretation, claims reserves, and settlement. Refers issues above authority level to the next level of management.
Uses the objective setting and performance evaluation processes to ensure employees understand the expectations, receive regular feedback, and are appropriately rewarded and developed. Deals decisively with performance and/or conduct issues using the performance management process.
Ensures technical resources are engaged in assignments commensurate with their experience and job title and that direct reports receive a proper orientation, on-going technical training and development opportunities.
Ensures compliance with related legislation, corporate policies, and programs.
Monitors new and emerging exposures and coverage issues and makes recommendations to Regional HO Management regarding same. May periodically conduct desk audits.
Assumes a leadership role with Regional/HO Management and other departments with new business and/or renewal presentations and periodic service calls.
Demonstrates an exceptional ability to capture, extract and analyze data specific to existing and emerging risk.
Can make and implement recommendations related to said analysis.
Involved in the analysis and implementation of
new and revised policies and procedures.
Demonstrates a consistent high level of expertise in complex workers compensation issues and successfully imparts that expertise to direct reports.
Qualifications:
Bachelor's degree, or equivalent work experience plus at least 7-10 years of progressively more responsible claims experience required. Prior management experience desired.
Ability to organize, lead and get work done through others; in depth knowledge of insurance products.
Advanced analytical skills to interpret business information drawn from multiple sources to make critical decisions.
Demonstrated team management skills and abilities.
Effective interpersonal skills needed to create and enhance partnerships with internal and external customers; including verbal and written communications
Benefits:
We recognize that talented people are attracted to companies that provide competitive pay, comprehensive benefits packages and outstanding advancement opportunities. For this reason we offer a Comprehensive Benefits Plan that includes the following:
401K and Company paid pension plan
Medical coverage
Dental coverage
Paid time-off
Pay-for-Performance
Discounts on automobile and homeowner's insurance
Discount fitness memberships
Flexible spending accounts
Tuition reimbursement
Vision care coverage
Work/Life resources
Credit Union membership
Employee and Dependent life insurance
Disability insurance
Accidental death & dismemberment insurance
Coordination of Benefits Claims Analyst - CVS Caremark - Scottsdale, AZ
Coordination of Benefits Claims Analyst more... ?
Job Category: Business Analyst Clinical Licensure Required : N/A Job Type: Full Time Position Summary: Responsible to review & interpret claims data in all adjudication platforms. Perform complex reviews/audits of claim adjustments/recoveries/reconciliations for Medicare Part D plans. Analyze the accuracy of participant's accumulations and financial adjustments. Validate the execution of proper controls/procedures. Work with internal and external partners to resolve Coordination Of Benefits related issues by developing new processes and procedures ensuring that beneficiaries, providers and clients are made financially whole. Work with CMS, federal and states agencies in COB related efforts to ensure proper reimbursement to primary and or secondary payers. Responsible for meeting or exceeding turnaround time standards and quality expectations. Communicate effectively; express thoughts in a clear, concise manner in both individual and group situations.
Essential Job Functions: -Work with CMS, federal and states agencies in COB related efforts to ensure proper reimbursement to primary and or secondary payers. -Effectively plan, prioritize, organize time and workload -Effectively present information and respond to questions from internal and external personnel. -Accurately research and adjudicate claims in order to arrive at expected outcome -Perform complex reviews/audits of claim adjustments/recoveries/reconciliations for Medicare Part D plans -Work with internal and external partners to resolve Coordination Of Benefits related issues by developing new processes and procedures ensuring that beneficiaries, providers and clients are made financially whole.
Required Qualifications: -Excellent written and verbal communication skills -Well organized with the ability to effectively handle multiple priorities - Ownership and results driven - Attention to detail - Able to handle high volume receipts within defined turnaround times coupled with excellent quality - Expert proficiency in Microsoft Office Excel - Working knowledge of accounting principles - Ability to effectively work within a team - Flexible in adapting to change - Demonstrated ability to analyze data and determine conclusions - Ability to learn and apply increasingly complex concepts, policies and procedures - Ability to effectively plan, prioritize, organize time and workload - Ability to work successfully in a deadline-oriented environment Preferred Qualifications: 3+ years relevant experience. Previous Coordination of Benefits/Medicare Secondary Payer Experience, Pharmacy, Healthcare preferred Education: Bachelor's Degree or equivalent work experience required Business Overview: CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nations largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units Minute Clinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers. turnaround BETS_ARC_Setter BACH_6df36a in times research personnel
Disability Claims Representative Trainee - Phoenix - Liberty Mutual - Phoenix, AZ
Disability Claims Representative Trainee - Phoenix
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31297
Description
Launch your career at Liberty Mutual - A Fortune 100 Company!
Have an investigative nature? Like to understand all the details and contributing factors before you make decisions? Like helping people resolve questions? Claims might just be right for you.
If you join our Group Benefits claims team, Liberty Mutual starts you off right with a comprehensive training program, one-on-one mentoring, and on-the-job training. ...
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