Adjudication Lead, Sr

Description

Combined Insurance a Chubb Company is seeking a Sr. Adjudication Lead to join our fast-paced high energy growing company. We are proud of our tradition of success in the insurance industry of over 100 years. Come join our team of hard-working talented professionals!

Job Summary

The Senior Adjudication Lead role will guide and support the efforts of a small (6 8 staff) Claims Adjudication team to meet production and quality goals working closely with their assigned Claims Adjudication Manager. This will include reviewing and approving medium and complex claims handled by their assigned adjudication team to authorize claims payments (over authority review) review denials and generally assess the quality of work from their adjudication team. The role will also monitor and assist with Claim escalations from customers or other service areas to ensure any concerns or issues with claims assigned to their team are handled in a responsive customer centric manner.

This position will also emphasize developing the craft of claims adjudication at each complexity level by working closely with each team member to assist with questions issues and the development of their adjudication skills. The Senior Adjudication Lead will work closely with the Claim Adjudication and Customer Experience Practices Leader to design and implement improved adjudication practices and enhanced customer interactions that will allow us to provide the service experience our customers expect.

To succeed the Senior Adjudication Lead must have deep technical expertise in all aspects of our systems and knowledge of the claim adjudication processes and procedures for all of our A&H products. They are expected to develop a collaborative relationship with the Adjudication team they are helping to lead while also assisting them to overcome challenges and develop their skills and capabilities. Person in this role must have strong coaching skills that reach people at an individual level which ultimately impacts the performance of team at large.

While this role will work extensively in support of our internal claims staff they will also need to monitor and understand the performance of our FNOL SAT CPT teams & peers as it may be impacting the performance of their adjudication team. They will work with their Manager and Director as needed to ensure effective end-to-end administration of claims handling with a focus on an exceptional customer experience. The Senior Adjudication Lead also seeks to enhance our claims handling capabilities to meet current and future strategic business needs with new products distribution channels policy administration / claim systems and strategic partnerships.

Responsibilities

• Assists their assigned Adjudication Manager with monitoring workload productivity and quality for the team. This includes helping to ensure work assignments are appropriate to skill level and Tasks are completed within target SLAs to meet time-service expectations
• Assists the team with complex A&H Claim Adjudication tasks and reviews claims payments that are over the authority level of the adjuster handling the claim or reviews and signs off on denied claims. Interacts internal & external resources as needed to influence positive outcomes for the case
• In collaboration with their manager coaches and provides ongoing training and guidance (both technical and behavioral) to all complexity levels of Combined Adjudication staff assigned to them (5-7 staff). This includes developing the Adjudication staff in claim investigation letter writing & customer interactions
• Facilitates daily and weekly team huddles with a focus on the skill of claim handling including discussion on claims adjudication best practices resolution of problems and issues and ensuring the best possible customer experience
• Through their normal course of job duties monitors the performance and work quality from the supporting FNOL SAT and CPT teams to ensure their Adjudication team is receiving quality timely work and assistance from these teams. Works with their Director Claims Adjudication Manager and FNOL SAT and CPT Team Managers to address issues and concerns as needed
• Involved in and assists with escalation management for their adjudication team and assists as a point of contact for issue identification and resolution for day-to-day problems that put customer / client experience at risk
• Reviews payment & denials that are over authority and performs claim signoffs on denied claims
• Communicates with customers state insurance departments the Combined Legal team and other internal and external areas. Has both technical and administrative responsibilities in file recreation and complaint handling (DOI / BBB)
• Monitor report and respond to consumer social media complaints (Facebook Glassdoor Tweets etc.)
• Identifies and recommends claims operational improvements to increase efficiencies
• Partners with and contributes to the departments success by being a technical expert in all systems / products and is utilized as a SME when called upon
• Suspends Payments
• Spot checks quality performance as needed (late notice outpatient surgery HCH reviews etc.)
• Oversight in complex claims involving Legal SIU MD & Rescission
• Performs other duties as assigned

COMPETENCIES

Skills

Educationand Experience

Required Experience :

Senior IC

Key Skills

Administrative Skills,Facilities Management,Biotechnology,Creative Production,Design And Estimation,Architecture

Employment Type : Full-Time

Experience : years

Vacancy : 1