PLADS Claims Technical Specialist

• Serves as a mentor for new hires as well as supports new hiring training

• Takes an active role in refresher training and developing of existing staff

• Ensures case managers are utilizing appropriate risk management skills to secure the appropriate claim outcome

• Conducts manager reviews/ audits of claims as necessary to ensure overall quality

• Provides the appropriate coaching and feedback to case managers as needed

• Monitors KPIs and reports to ensure service levels and commitments are met, working with case managers as needed

• Monitors and adjusts workload balancing for case managers

• Provides support to the manager in facilitating team meetings/ huddles

• May periodically manage very complex cases directly

• Elevates any trends and / or coaching opportunities to the leadership team

• May manage customer escalations

• Completes special projects and/or ad hoc assignments as requested by the leadership team

• Performs other related duties as required

Education & Experience Required

• Bachelor’s Degree in a related field

• 5 years minimum industry experience
• 2 years minimum working with Employees

Or an equivalent combination of education and experience

Job Knowledge & Skills

• Ability to influence and champion change

• Excellent critical thinking and decision -making skills

• Strong leadership and organizational skills

• Excellent Communication skills (verbal, written & presentation)

• Strong understanding of contracts, plans and products

• Strong knowledge of best practices and effective case management skills

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 customer expectations

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