Supervisor, Medical Only

SUMMARY:

Effectively supervises the day-to-day work and team performance of the Non-Exempt Medical Only Claim Specialists to ensure the goals and customer service expectations are met. Acts as a direct supervisor for non-exempt claim professionals handling assigned claims. Responsible to supervise all aspects of this team and work with other departments as it relates to process, workflows, and continuous improvement opportunities which may cross departments. Identify ways to continuously improve claim process and workflows. Objectively evaluate opportunities against objective results or historically reports to support changes. Works with managers and employees to identify methods of improving employee performance and closing performance gaps. Responsible to work with peer Supervisors and Claim Management team to ensure all training is coordinated and delivered in a timely manner. Must know all training materials and have ability to deliver these materials with limited notice. Must be able to recommend training tools/formats to management team and create reviews or reports to ensure training supports positive change in execution or results.     

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Organizational Development and Design 

• Serve as a coach, removing operational barriers that result in employees not achieving the operational objectives.
• Ensure team meetings are routinely scheduled to discuss customer service, performance results, operational issues, and provide all team members the opportunity to explore alternative approaches to exceed the current performance levels.
• Provide opportunities for and encourage professional growth of individual team members.
• Effectively develop, prioritize and implement project plans as assigned by management.
• Research opportunity causes and make recommendations.

• Responsibility for balancing workload to optimize the effectiveness of the department.

• Works with peers to establish new hire training delivery agenda and execution of all training needs within the AFICA claims department. 

• Works with peers to develop feedback loop with those trained and their direct managers to constantly improve training material and delivery. 

• Work with claims management team to identify opportunities in the initial tiering and reassignment of claims. 

• Work with staff to prepare them for additional work assignments such as handling limited lost time assignments or new jurisdictions. 

• Monitor all aspects of team for compliance with all state jurisdictional requirements, such as license, forms, payment time frames, and other specific requirements on claims handled. 

• Completes all required reviews/audits of claims timely and presents to individual staff members in appropriate format as outlined in Union contract.

• Completes all performance assessments evaluations and reviews in compliance with agreed upon Union contract.  

• Understands Union contract and works with HR on any issues that may not be covered in the contract.
• Executes plan to have coverage for any team member who is away from the office more than one day and implementation of standard plan for away greater than 5 days to cover all aspects of individuals desks.

Change Management

• Provides change management and transitional consulting services, which may include assessment of the current or future change initiative, consultation re-design and implementation of change and transition process, and training. 

• Develops change management initiatives designed to build a culture of innovation and inclusion. 

• Develops strategic plan to have staff trained, licensed, and ready to handle claims in other states to provide backup to others, or to allow for support of expansion into new jurisdictions.

Learning and Development

• Designs/develops training agenda and plans.

• Conducts job/task analysis/assessment of employee and position learning needs in collaboration with managers and others.

• Measures and evaluates training outcomes and effectiveness using various evaluation methods.

• Researches best practices and emerging trends in employee education and training.

• Manages training related projects and conducts training, as appropriate.

• Develops and prepares necessary reports and manuals related to job responsibilities.
• Participates in development of annual education goals, objectives and budget.

• Works with minimum supervision and exercises sufficient discretion and independent judgment.

EDUCATION AND EXPERIENCE:

• Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree.  Continuous learning, as defined by the Company’s learning philosophy, is required. Certification, or progress toward certification, is highly preferred and encouraged.

• Five years of experience in a claims environment, previous worker’s compensation with multi-jurisdictional experience preferred. Demonstrated three to five years of leadership experience that provides the necessary knowledge, skills and abilities to manage staff.  Bilingual skills preferred.

QUALIFICATIONS

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 accommodation may be made to enable individuals with disabilities to perform the essential functions.

OTHER SKILLS AND ABILITIES: 

• Demonstrated leadership ability.
• Knowledge of team building and employee motivation theories with the ability to manage employee teams.
• Knowledge of laws, regulations, and compliance requirements related to workers compensation.
• Ability and proficiency in the use of computers and company standard software specific to position.
• Demonstrated technical knowledge of insurance administration, claims management, underwriting and/or relevant insurance expertise.
• Ability to optimize loyalty, customer satisfaction and retention by maximizing the value of every customer touch point.
• Ability to interact with others to build consensus and get decisions implemented.
• Effective oral and written communication skills.
• Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
• Ability to establish workflow, manages multiple projects and meet necessary deadlines.

SUPERVISORY RESPONSIBILITIES

Directly supervises a varied number of employees in the designated department(s). Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

ADDITIONAL INFORMATION 

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.

 PAY RANGE: 

“Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $90,600 and $151,800.”

We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis.  Nothing herein is intended to create a contract.

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