Claims Manager (Remote) (Finance)

The Manager Claims Support will report to the Director of Claims, in the H&B Core Operations Department. This role is responsible for the Claims Quality, Appeals, Resource Allocation Decisions (RAD's) and Hardship Activations departments. Responsible for the proactive minimization of risk, appeals, and claims payment errors, during quality reviews. Holistically, educating current teams and partner departments on trends to cultivate awareness and continuous improvement.

Duties & Responsibilities:

• Oversee multi-functional teams that support the claims processing department, i.e., Quality, Appeals, Resource Allocation Decision's (RAD) and Hardship Activation Diaries.
• Develop, monitor, track, analyze and trend performance, for each applicable client and claims processor; recommends specific actions and/or remedies, as necessary.
• Execute strategic planning and training with a focus on cultivating an agile, efficient, and cost-effective Quality, Appeals and RAD ecosystem.
• Attract, select, and retain high caliber, diverse talent able to successfully achieve or exceed business goals.
• Maintain expertise in systems, and applicable applications (CBAS, Laserfiche, QuickBase, SharePoint, etc.) to advance departments, teams, and processes.
• Utilize independent leadership skills to manage aligned departments to the goals of the Center of Excellence (COE).
• Create and consistently maintain tools, job aids, and training materials throughout the course of business and conduct annual signoff reviews to ensure resources are accurate and up to date.
• Maintain effective communication with Claims, Member Services, and other departments.
• Establish a clear vision aligned with company values; set specific challenging and achievable objectives and action plans.
• Motivate others to balance customer needs and business success; challenge self and others to look to the future to create quality products, services, and solutions.
• Attract, select, and retain high caliber, diverse talent able to successfully achieve or exceed business goals; build a cohesive team that works well together.

Managerial Responsibilities:

• Recruits, interviews, hires, and trains new staff.
• Oversees the daily workflow of aligned department(s).

• Assess and document individual and team performance monthly and throughout the month to provide candid and timely developmental feedback and performance management, as needed.

• Document and maintain employee's monthly one on ones, quarterly, mid-year and annual reviews within the system for timely evaluations.
• Increase and maintain knowledge and awareness in all applicable products by obtaining additional training and assisting with tasks commonly assigned to direct reports.
• Ensure adherence to department metrics, and quality, to meet and/or exceed service levels and performance guarantees.
• Set team priorities, allocate resources, and manage to team cohesion.