Claims Adjudication Manager - Group A&H Insurance (337805)
is seeking a Claim Adjudication Manager, Group A&H Insurance to join our fast-paced, high energy, and growing company. For nearly 100 years in the insurance industry, our company has been passionate about serving our customers and providing them peace of mind and protection when they need it the most. Come build your career here, along with other positive, hard-working, talented professionals—just like you!
Lead all key operating functions of the group A&H Claim Adjudication units located in Chicago, Illinois. Ensure that Claims submitted from claimants from our Group Clients are processed in timely and accurate manner to meet all service SLAs and Quality standards. This includes monitoring and managing Adjuster workload, productivity, and accuracy and taking appropriate actions to mitigate any problems or issues that arise. The role also provides vision and leadership for the development and implementation of various claim initiatives to improve and enhance the capabilities and performance of the Group Claims adjudication team and the service experience for our customers. These initiatives and improvements should align with the company’s mission, objectives and strategies.
- Direct and oversee day-to-day activities of the Group Claim Adjudication units to achieve service level objectives and ensure the smooth and efficient delivery of services to Worksite, PFP and other Combined Integrated Salesforce (CSI) customers, employer groups, brokers, and medical providers. Leverage the Claims dashboard, service reports, and other resources to ensure time-service, productivity and quality standards and Key Performance Indicators (KPIs) are met each day
- Monitor and manage the Group Claims adjudication process to ensure work is properly distributed and balanced, claims adjudication tasks and claim settlements are completed within SLA, problems, issues and service escalations are properly addressed, and team performance meets service, productivity, and quality standards
- Understand and monitor the end-to-end service experience for Group Claims customers, employer groups and brokers to identify problems and opportunities for improvement. Work with the Claims Adjudication/Customer Experience Improvement lead, the Claims Quality and Audit team, the Claims Systems Administration and project team, and others to design and implement improvements and enhancements
- Ensure all Group Disability, Accident, Health, Critical Illness and other A&H claims are processed in compliance with key metrics around customer service and file quality
- Work with the Senior Claims Adjudication Leads to complete audit and quality assurance reviews and provide coaching and support to Claims adjudication staff as needed to ensure quality and performance standards are consistently met
- Promote a culture of high performance and continuous improvement that values learning and a commitment to quality
- Take a leadership role in assisting with the implementation of continuous improvement activities/projects for operational processes to increase efficiencies, enhance quality, reduce costs, standardize systems, and/or add value for both internal and external clients
Business Partnership, Strategy and Alignment
- Provide strategic leadership in the development, execution, and monitoring of Claims Adjudication policies, procedures, and initiatives that align with corporate goals and strategies
- Collaborate with and maintain a strong partnership with Worksite, Chubb Workplace Benefits, and sales leadership teams. This includes ensuring timely and responsive communications regarding claims servicing inquires, problems, or issues and proactive management of root causes to eliminate future concerns.
- Develop and execute custom or specialty claim service and issue resolution strategies for our Worksite Solutions/ CSI sales channels to meet client requirements
- Provide leadership and technical expertise to achieve profitable growth in our group products working with the Claims SIU team, Legal, and Actuarial to ensure claims are handled in accordance with our policy contracts, fraud is identified and remediated, and loss ratios are properly managed
- Engage in the Group Product Development process to ensure Claims handling requirements are properly considered. This includes recommendations that will help simplify the adjudication process and make benefits easier to understand and pay, recommendations for the UW process that will minimize claims investigations and policy recessions, and helping to define how similar benefits are to be handled across multiple policy types and coverages