Claims Operations Manager

Are you driven to keep people safe? That's what we do every day at Missouri Employers Mutual.

We've created a casual, values-driven work culture that's making a positive impact on the way people live and work. This is a place where you can grow with confidence - because that's what safety and success really mean to us.

SUMMARY:

This leadership role is responsible for the planning, direction, management and implementation of strategic objectives and policies for our Claims Operations team in accordance with MEM Strategic Goals and Objectives. Working closely with the Technical Services Manager, Manager of Nurse Case Management, and the Director of Claims, this position ensures continuity of services and cross-functional collaboration. Additionally, this role is responsible for the consistent technical performance of our claims team, to include responsiveness to quality reviews, development/delivery of training, and maintaining accountability to established benchmarks and departmental goals. With support from the Claims Managers, this position will also be responsible for the overall administrative functions of Claims Operations, including the budget planning process and staffing analysis with the goal of ensuring the Claims Managers are focused on the results, coaching, and mentorship of the staff members they lead.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties or audits may be assigned such as audits requiring physical visit located within expansion states in proximity to the auditor's location.

People Leadership:

• Team Leadership: Lead, mentor, and manage a team of Claims Managers, fostering a collaborative and high-performance culture. Inspire and motivate the team to achieve both individual and collective goals.
• Performance Management: Set clear goals and expectations, conduct timely and regular performance reviews, and support professional development for team members. Identify skills gaps and arrange necessary training to ensure continuous growth and development.
• Recruitment and Onboarding: Participate in the recruitment process, including interviewing and selecting new team members. Oversee the onboarding process to ensure new hires are integrated smoothly into the team

Functional Leadership

• Provide leadership in accordance with MEM's corporate vision, mission and values.
• Provide oversight and management of all claim operations. Leads, directs, trains, mentors and has full management accountability for the performance of Claims Managers and the Claims Care team
• Measure, monitor, analyze and refinement of claim key performance metrics such as claim volume, ALAE, ULAE, reserve Adequacy, quality and staffing/resources within the claims department. Work in collaboration with the Technical Services Manager to provide direction and assistance as needed to help analyze losses, trends and monitor results within the claims department. Maintains and analyzes appropriate metrics, review protocols, governance and control mechanisms.
• Development of strategies and leadership of project teams charged with the implementation of improvements and best practices across people, processes and technology within the department to ensure attainment of metrics goals and elimination of negative trends.
• Ensure consistent policies and procedures are in place across the Claims Operations team to provide service excellence for all stakeholders, internal and external to the Claims team.
• Maintain a case care reserve authority of $500,000 in Indemnity and $500,000 in Medical, to discharge ultimate corporate liability with reasonable consideration for IBNR and adverse claim development.
• Implement claim policy and guidelines in compliance with corporate claim objectives and insurance laws and regulations. Drives continuous improvement within scope of responsibility through initiatives involving people, processes and technology. Includes identifying emerging issues and trends.
• Provide leadership and technical claim oversight of claim operations regarding coverage, compensability and workers compensation roundtable processes and analysis initiatives of high severity claims issues.
• Provide ongoing oversight of MEM's administrative services provided outside of Missouri to ensure adherence to all agreed upon service standards and procedures.
• Provide leadership and management support to the Claims Operations teams to ensure timely and appropriate customer service to the injured worker and policyholder, while maintaining claim financial results.
• Implementation of strategic objectives with substantial impact on the short-term success for claims management process across the workers compensation portfolio.
• Ensure that the department maintains adequate case reserves on all current and new claims reported. Ensure the company maintains claims case reserves, in the aggregate, which are sufficient to discharge ultimate corporate liability.
• Support the efforts of Claims Technical Services in the preparation and administration of reinsurance claim audits and reviews.
• Generates management reports on all facets of the operations. Shares the information as appropriate and identifies and implements corrective action where needed.

• Maintain log and report Serious Claim losses, results, and activities and cost data on a weekly basis to the appropriate claims and executive staff teams.
• Maintain log and report Risk Alert notices on a weekly basis to the appropriate claims and executive staff teams
• Represent MEM at industry events that require input on any elements of claims file management provided.
• May serve as point of contact for some vendor relationships including outside legal panel firms.
• Assist the Director of Claims with other projects and/or programs as assigned.

Collaboration & Communication

• Organizational Collaboration: Collaborates across various levels of management across the company, within the workers compensation line of business to improve operational effectiveness, customer service and quality in a timely manner to track claim department progress and corporate strategic progress.

• Cross-functional Collaboration: Partner with the Director of Data and Analytics to align data engineering efforts with overall business objectives and strategy. Collaborate with Data Science and Analytics teams to support their projects and initiatives with robust data solutions
• Stakeholder Engagement: Communicate effectively with stakeholders to provide updates on projects, identify risks, and offer solutions. Build strong relationships with key stakeholders to understand their data needs and provide timely and effective support.
• Knowledge Sharing: Foster a culture of knowledge sharing within the team and across the organization. Encourage team members to share insights, learnings, and best practices with their peers.

QUALIFICATIONS:

Education:

Bachelor's degree required

Designations/Certifications:

• SCLA, CPCU and / or AIC designation beneficial.

Licenses

• A valid driver's license is required.
• Claim adjusting license beneficial, but not required.

Experience:

• 10-15 years' related workers compensation claim and progressively responsible experience.
• Experience in workers compensation laws in the states contiguous to Missouri is preferred.
• Some experience in property and casualty liability claims preferred but not required.

Our home office is located in vibrant Columbia, Missouri - #6 in Livability's 2019 Best Places to Live.

Other details

• Pay Type Salary
• Travel Required No
• Required Education Bachelor's Degree

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