Manager, Claim Administration - Michigan Based

Blue Cross Blue Shield of Michigan•Lansing, MI

About The Position

SUMMARY Provide leadership and direction to a claims operational team. Act as a primary, independent, visionary and proactive authority; providing in-depth analysis of claims operational areas including statistical, industrial and regulatory perspectives. Provide operational consistency and integrity to claims. Serve as a technical expert with regard to department operations. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Directly manage and carry out managerial responsibilities in accordance with enterprise policies and applicable laws. Responsibilities include interviewing, hiring and training employees, planning, assigning, and directing work, appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems. Plan, direct, manage and evaluate the day-to-day operations and workflow of production, claims management and customer teams. Consult with claims management across the organization to provide necessary claim support and ensure most productive and cost-effective ways to conduct business. Responsible for staying current on changes in workers’ compensation statutes and cases, as well as subrogation and recovery laws and procedures. Responsible for developing and implementing policies, practices and procedures. Conduct advanced statistical analysis and research related to claims and claims operations. Serve as department representative to customer inquiries, brands and enterprise. Oversee and manage strong, professional working relationships of state departments, as well as vendors by serving as a key contact. This would include ensuring quality communication and exceptional work products. Oversee state filing projects (i.e., quarterly benchmarking as well as annuals) to ensure timely completion. Keep detailed records of all delays, surcharges and fines received from multiple jurisdictions. Participate in development of annual departmental budget. EDUCATION AND EXPERIENCE Relevant combination of education and experience may be considered in lieu of degree Bachelor’s degree in insurance, business or a related field Continuous learning required, as defined by the Company’s learning philosophy. Certification or progress toward certification is highly preferred and encouraged. Five (5) years of experience of progressive responsibility in a claims environment with demonstrated technical knowledge that provides the necessary skills, knowledge and abilities. W orking knowledge of workers' compensation statutes, filing procedures, settlement options, claims processes, and medical terminology. M inimum three years of demonstrated leadership ability in a claims environment required. QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. OTHER SKILLS AND ABILITIES Extensive knowledge of workers compensation insurance and the claims management process. Demonstrated leadership ability. Knowledge of team building and employee motivation theories with the ability to effectively manage multi-functional employee teams. Ability to bridge IT requirements and departmental needs. Ability to read, analyze and interpret financial information. Excellent oral and written communication skills. Excellent analytical skills to identify improvement needs and develop solutions. Ability to effectively exchange information clearly and concisely, present ideas, report facts and other information and respond to questions as appropriate. Strong interpersonal skills and the ability to negotiate while creating and maintaining mutually beneficial relationships with working partners. Ability and proficiency in the use of computers and company standard software, including advanced knowledge in Excel, Access and other corporate databases. Ability to establish workflows, manage multiple projects and meet necessary deadlines. Ability to comprehend the consequences of various problem situations and address them or refer them for the appropriate decision-making. Independently resolves most problems. Ability to make competent, independent decisions. Ability to effectively present budgetary and/or cost information and respond to questions as appropriate. Ability to maintain confidentiality. SUPERVISORY RESPONSIBILITIES Directly supervises a varied number of employees in the designated department(s). Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. ADDITIONAL INFORMATION The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.

Requirements

Bachelor’s degree in insurance, business or a related field
Five (5) years of experience of progressive responsibility in a claims environment with demonstrated technical knowledge that provides the necessary skills, knowledge and abilities.
Working knowledge of workers' compensation statutes, filing procedures, settlement options, claims processes, and medical terminology.
Minimum three years of demonstrated leadership ability in a claims environment required.
Extensive knowledge of workers compensation insurance and the claims management process.
Demonstrated leadership ability.
Knowledge of team building and employee motivation theories with the ability to effectively manage multi-functional employee teams.
Ability to bridge IT requirements and departmental needs.
Ability to read, analyze and interpret financial information.
Excellent oral and written communication skills.
Excellent analytical skills to identify improvement needs and develop solutions.
Ability to effectively exchange information clearly and concisely, present ideas, report facts and other information and respond to questions as appropriate.
Strong interpersonal skills and the ability to negotiate while creating and maintaining mutually beneficial relationships with working partners.
Ability and proficiency in the use of computers and company standard software, including advanced knowledge in Excel, Access and other corporate databases.
Ability to establish workflows, manage multiple projects and meet necessary deadlines.
Ability to comprehend the consequences of various problem situations and address them or refer them for the appropriate decision-making.
Independently resolves most problems.
Ability to make competent, independent decisions.
Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
Ability to maintain confidentiality.

Nice To Haves

Certification or progress toward certification is highly preferred and encouraged.
Continuous learning required, as defined by the Company’s learning philosophy.

Responsibilities

Directly manage and carry out managerial responsibilities in accordance with enterprise policies and applicable laws.
Plan, direct, manage and evaluate the day-to-day operations and workflow of production, claims management and customer teams.
Consult with claims management across the organization to provide necessary claim support and ensure most productive and cost-effective ways to conduct business.
Responsible for staying current on changes in workers’ compensation statutes and cases, as well as subrogation and recovery laws and procedures.
Responsible for developing and implementing policies, practices and procedures.
Conduct advanced statistical analysis and research related to claims and claims operations.
Serve as department representative to customer inquiries, brands and enterprise.
Oversee and manage strong, professional working relationships of state departments, as well as vendors by serving as a key contact.
Oversee state filing projects (i.e., quarterly benchmarking as well as annuals) to ensure timely completion.
Keep detailed records of all delays, surcharges and fines received from multiple jurisdictions.
Participate in development of annual departmental budget.