Claims Manager | Dedicated Client | MD, VA & DC Jurisdictional Knowledge

PRIMARY PURPOSE: To manage the technical and operational functions within a dedicated client; to ensure consistent delivery of quality services; to manage staffing and training needs of specified unit; and to oversee budget preparation and profit and loss management within the dedicated client program.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Responsible for overall operational management for assigned dedicated client.
• Oversees company and client internal quality review process and reports monthly.
• Establishes policy and procedure to ensure compliance to best practices, claims management services standards, state regulations and client service requirements; ensures compliance with client internal controls, audit requirements and service agreement requirements; plans, develops and implements team, policies and procedures for dedicated client activity.
• Establishes business plan with goal and objectives for the partnership of the dedicated client.
• Works with Program Management to:  (a) make recommendations for cost savings strategies for client and partners; (b) keep client, program manager and colleagues informed of statutory or regulatory requirements/developments by jurisdiction which may impact procedures; (c) resolve client issues; (d) communicate frequently with key client personnel; and (e) represent company as liaison to clients and partners.
• Identifies and resolves issues with company representatives.
• Monitors management reports relating to the dedicated client's performance.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Perform other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

SUPERVISORY RESPONSIBILITIES

• Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
• Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
• Provides support, guidance, leadership and motivation to promote maximum performance.

QUALIFICATIONS

Education & Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required.

Experience
Eight (8) years of related experience or equivalent combination of education and experience required to include five (5) years supervisory experience.

Skills & Knowledge

• Thorough knowledge of claims management procedures
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Leadership/management/motivational skills
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.