Job Summary
The Manager, STD/Leave is responsible for management and administration of multiple functions, or management of general business operations within Disability Claims Department.
Principal Duties & Responsibilities
- Oversee daily operations of multiple levels of staff and multiple functions across one or more business units
- Manage day to day site operations, and accountability for financial and non - financial results (budgets and actuals)
- Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting Insurance and Leave of Absence claims
- Attend/participate in select customer meetings as appropriate to discuss feedback and/or needed process enhancements.
- Initiates and maintains partnerships with others throughout the organization. Encourages cooperation by promoting common goals and building trust. Inspires, supports, and initiates cross[1]functional activities.
- Authorize the appropriate payment or refers claims to investigators for further review
- Analyzes and identifies trends and provides reports as necessary
- Lead project management and implementation initiatives
- Identifies trends and assist in developing creative solutions to improve overall efficiencies of Short Term Disability and leave of Absence processes
- Analyzes and distribute daily reports and ensure Performance Guarantees and critical claim indicators are consistently met
- Consistently cascade critical compliance and process updates to team members; provides appropriate oversight to ensure team successfully achieves targets to meet Performance Guarantees; supports employee development by conducting regularly scheduled 1x1s with direct reports; coaches and develops direct reports to advanced claim management practices
- Travel Less than 10% of the time
- Performs other duties as required
Education & Experience Required
- Bachelor’s Degree in a related field
- 5+ years of claims industry experience
- 5+ years of Supervisory, Managerial, and / or leadership experience in claims adjudication or customer service
- 2+ years of experience managing relationships with clients and / or vendors
- 2+ years of experience managing budgets, process improvement and quality assurance
Education & Experience Preferred
- Operation Excellence (Six Sigma) experience
Or an equivalent combination of education and experience
Job Knowledge & Skills
- Experience using specific medical and/or behavioral health criteria or protocols
- Extensive clinical experience/knowledge
- Strong customer service skills
- Strong written and oral communication skills.
- Strong organizational and time management skills
- Ability to analyze clinical records in the context of functional capacity
- Kean instincts on how to work in a team environment
- Pass Applicable certification and licensing continuing education and maintain active license and/or certification, as required.
- Seeks and/or maintains current or enhanced profession credentials.
- Proficiency within Microsoft Excel (ability to create pivot tables, basic formulas, sorting, and read data)
- Solid understanding of the regulations governing FMLA, Statutory Disability and ERISA as it relates to absence programs
Competencies
- Acting with Integrity - Clearly states goals and beliefs; lets people know his/her true intentions; does what he she said they would do; follows through on commitments
- Communicating Effectively - Expresses ideas and information in a clear and concise manner; tailors message to fit the interests and needs of the audience; delivers information in a manner that is interesting and compelling to the listener
- Pursuing Self-Development - Demonstrates ambition and desire to move forward in his/her career; engages others in discussions about career development; seeks feedback on ways to increase his/her performance; takes advantage of opportunities to build new skills and capabilities
- Serving Customers - Builds strong relationships with customers; stays aware of customer needs, concerns and satisfaction; responds promptly to customer questions and requests; effectively manages
- Supporting Change - Enthusiastically participates in new change initiatives and programs; focuses on reasons why changes will work and how they will be beneficial
- Supporting Organizational Goals - Actively supports organizational goals and values; demonstrates enthusiasm toward the company's goals and mission; aligns actions around organizational goals
- Working with Diverse Populations - Shows respect for the beliefs and traditions of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds
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