Claims Quality Audit Director jobs in Harrisburg, PA

The County Commissioners Association of Pennsylvania (CCAP) is the voice of Pennsylvania counties. CCAP provides county leaders with information and guidance related to legislation, education, media, insurance, technology and many other issues that help create and maintain crucial services for residents throughout the state.

CCAP supports county leadership that is responsive to the needs and circumstances of citizens. CCAP stands firmly against state and federal actions that limit fiscal, administrative or programmatic authority over those developed locally.

CCAP Insurance Programs Mission

It is the mission of the CCAP Insurance Programs office to assist counties and county related entities to protect their employees, clients, their property, and financial assets, and the general public which use their facilities.

To accomplish this, CCAP Insurance Programs staff will strive to provide:

• Quality member services to counties and county related entities in the area of risk management, insurance, employee benefits, bonding, and related areas.
• Professional, fair, timely and accurate claims services to members of CCAP Insurance Programs.
• Professional advice to counties and county related entities regarding loss control, safety, contractual and operational issues.
• Quality loss control training for management, supervisors and employees of counties and county-related entities.
• Regular, relevant information to members and their insurance producers through the use of various media. Any reasonable assistance to counties and county related entities to make their workplace and operations as safe as possible for the public and county employees.

CCAP is looking to recruit a Claims Director to lead our Claims Team within our Insurance Department.

The Claims Director is employed by CCAP to supervise the association’s claims staff teams and to ensure claims are professionally managed and administrated for the members of the association’s insurance programs.

In fulfilling the responsibilities of the position, the Claims Director will lead and direct the claims teams to satisfy the requirements contained within each contract between CCAP and the appropriate insurance program.

The Claims Director is part of the management team of the CCAP insurance programs, performs most work with nominal supervision, and reports to the Managing Director, Insurance Programs for general direction and work evaluation.

JOB DESCRIPTION:

Claims Director

Overview:

The Claims Director is employed by CCAP to supervise the association’s claims staff teams and to ensure claims are professionally managed and administrated for the members of the association’s insurance programs.

In fulfilling the responsibilities of the position, the Claims Director will lead and direct the claims teams to satisfy the requirements contained within each contract between CCAP and the appropriate insurance program.

The Claims Director is part of the management team of the CCAP insurance programs, performs most work with nominal supervision, and reports to the Managing Director, Insurance Programs for general direction and work evaluation.

The Claims Director also provides support to the general operations of the insurance department, including assisting with presentations for stakeholders as needed, the contribution of analyses and other background material for use in CCAP’s lobbying efforts, and other similar duties.

This position is eligible for telework pursuant to CCAP’s telework policy.

Responsibilities & Essential Functions:

Management & Supervision:

• Supervision of the Claims Supervisors and/or Team Leaders, Claims Representatives for PCoRP, PComp, PELICAN and COMCARE PRO and the claims support staff.
• Responsible for providing input into the strategic staffing plan of the claims staff structure and executing the tactics to accomplish the strategy
• Leading and assisting with the recruiting, onboarding, performance management and development of the claims team
• Accountable to work with appropriate staff within the Insurance, Finance and other CCAP departments to provide financial oversight and management for budgets relating to each of the respective insurance programs.
• Accountable to work with related service firms who support the respective programs

Operations:

· Provides guidance on claims, establishing the proper reserves and monitors files in litigation.

· As needed, reviews litigation performed by legal counsels for insurance program members, in conjunction with Insurance Boards Legal Counsel.

· Approval of claims reserves and payments at various authority levels as specified in the Claims Manual.

· Preparation and managing approvals for all claims settlement authorities from the appropriate boards and committees.

· Performs check signatory and check ledger review responsibilities as outlined in the Claims Manual, and within authority levels set by insurance program boards of directors.

· Acts as an information source for the insurance programs staff, provides information to current members, prospective members, producers, claims administrators and others concerning regulations, policies, coverages and procedures.

· Responsible for the Claims Manual for CCAP Insurance Programs, and training of claims staff in policies and procedures.

· Responsible for the regular maintenance and upgrades of the claims software system, including management of historical claims information and claims files documentation retention and destruction.

· Tracking and review of claims data to ensure retentions, limits, and/or sublimits are not exceeded, reinsurance recoveries are collected, claims trends and volume, claim representative caseloads.

· Responsible for annual file recon of PCoRP, PComp, and PELICAN claims files to ensure adequate claims reserves, appropriate file handling, and review of plans to resolve the claim.

Board Responsibilities and Reporting:

• Preparation of required reports and providing necessary data for insurance regulators, Labor & Industry, actuaries, auditors, etc.
• Responsible for compliance with Medicare Section 111 mandatory reporting for PCoRP, PComp and PELICAN. This includes monthly querying of all applicable claims which have the potential to be reported to Medicare.
• Responsible for oversight and administration of the process for PCoRP, PComp and PELICAN to comply with federal 1099 reporting.

· Preparation of reports for CCAP insurance program boards of directors and committees.

Contract & Vendor Management:

• Participation in various service provider contracts and program coverage document reviews.
• Management of the defense counsel panels for PCoRP, PComp and PELICAN.
• Oversight of contracts and services from outside vendors for peer review, utilization review, bill repricing, and other services for PCoRP, PComp and PELICAN.

General Responsibilities:

• Participation in the long-range planning for CCAP insurance and member service programs.
• Assistance with training and educational sessions for program board members, Insurance Programs staff, and program participants.
• Assistance with the marketing of CCAP programs and services.
• Performance of other assignments and routine business of the association.

Qualifications and Requirements:

Experience:

• Four years of insurance claims experience, ideally including experience with underwriting, marketing, public entity pooling and nursing homes.
• Knowledgeable concerning workers’ compensation and property/casualty insurance claims issues, management and analysis.
• Knowledge of the Pennsylvania Political Subdivision Tort Claims Act, and experience with the defense of insurance claims filed against the state, counties and/or municipalities.
• Experience in leading and developing a high functioning team – including recruitment, performance management, training and professional development.

Education:

· A Bachelor’s Degree, preferably in business administration, public administration, an insurance or risk management field.

· A proven history of professional growth and a commitment to acquiring and maintaining the knowledge required to perform in the position.

An equivalent combination of experience and education will be considered satisfactory for the position.

Required Skills and Knowledge:

· Attention to detail and the ability to independently problem solve with minimal oversight.

· Excellent verbal and written communication skills.

· Highly computer literate with capability in email, MS Office, databases, insurance claims software and related business and communication tools.

· Strong decision making and problem-solving skills.

· Strong time management skills.

Working Conditions and Physical Requirements:

· The standard office hours of the Association are 8:30am - 4:30pm.

· Periodic travel will be required, primarily within the state of Pennsylvania, to CCAP members, insurance producers, board and committee meetings, and workshops and other partners as needed

· Periodic travel outside of Pennsylvania for renewal meetings and training conferences.

· The position may require standing or sitting for extended periods of time and the ability to operate computer equipment essential to the completion of the position’s responsibilities.

FLSA: For purposes of the Fair Labor Standards Act, this position is a full-time exempt position.

Job Type: Full-time

Pay: $85,000.00 - $90,000.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Retirement plan
• Wellness program

Work setting:

• Hybrid work
• Office

Work Location: Hybrid remote in Harrisburg, PA 17110