As a member of the Claims Operations and Program Management Team, you will perform a number of diverse roles and be engaged in multiple assignments. Depending on assignment, you may be functioning as a business analyst, project leader, trainer or subject matter expert and may be engaged in more than one work assignment at any given time. Team members will serve as liaisons and lead representatives for the Insurance Company and TPA Claims business units.
Analyze, develop and implement recommendations (modifications/enhancements) to support the objective of continuous improvement within our claims processing model. This purview will include all facets of the processing model, as well as all impacted departments and companies.
Optimize engagement and ensuring successful adoption of new changes through defining and implementing project plans that align communication, training, and business process deliverables.
Effectively represent the interests of the claim department(s) for assigned projects, and engage the claims team when needed for business direction.
Lead responsibility for the ongoing maintenance and enhancement of the ClaimCenter application to support the needs of the claims processing model.
Project leadership for claims related projects and work efforts.
Analysis and oversight of jurisdictional reporting requirements.
Identify, escalate and work to resolve issues that serve as project roadblocks and/or place project objectives at risk.
Create and maintain project specific documentation and effectively utilize project management tools/applications.
Knowledge of Claim Handling applications, Client Services applications, Client Billing applications, Cash Disbursement System, Data Warehouse applications, and PMA Business Partner relationships and services is a plus.
Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
Advanced business operations knowledge in the area of Workers Compensation claim handling (Property, Auto, Liability experience a plus).
High level of credibility and demonstrated expertise within the claims department.
Minimum of 5 years' experience as claim handler or claim related business analysis.
Knowledge of Claim Center; PMA Claim Center experience a plus.
High School diploma or equivalent experience, defined as 8 to 10 years professional level experience, required, college degree preferred.
Knowledge of claims management (experience as a claim handler preferred), workflow and claims systems.
High level of proficiency with MS products (Excel, Word, Power Point, etc.)
Strong communication, organizational, analytical, critical thinking, team building, and multi-tasking skills.
Customer service focus.
Deadline and detail oriented.
Ability to investigate and analyze the current processes and systems.
Ability to effectively communicate (verbally and written) process analysis and recommendations.
Ability to work well with others and collaborate in a team environment.