Health Insurance Operations Director jobs in Bangor, ME

MMG INSURANCE COMPANY

Job Description

 Job Title:              Claims Director

Department:       Claims

Reports To:          Vice President of Claims

FLSA Status:        Exempt

SUMMARY

Provides strategic direction, oversight, operational direction, and overall management of the Casualty Unit. Implements and monitors severity, complexity, and quality assurance standards and procedures. Proactively participates with the senior claims management team in developing and executing strategic plans to meet business objectives. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Provides strategic direction and leadership for the Claims Department. Develops, plans and implements strategic and tactical claims operational improvements with the objective of delivering superior claims results to policyholders and the company.
• Develops and implements effective claims management policies, procedures, and organizational structure for the claims department. Collaborates with senior claims management to develop and implement tactical plans to optimize workflows and maximize results across the organization.
• Monitors and analyzes organizational performance. Develops and analyzes key performance metrics. Implements, monitors, and maintains quality assurance in claims via the audit process.
• Leverages management information to enhance team performance and identify trends. Drives for performance at all levels, holding each member of the team accountable for meeting stated performance metrics and objectives. Implements, monitors, and maintains effective and efficient cost containment programs.
• Monitors high severity, complex and/or litigated claims and makes reserve and settlement decisions for cases exceeding staff authority levels.
• Drives change to assure continuous improvement. Collaborates with cross-functional leaders to identify and implement strategies to improve results and contribute to the business goals of optimized profitability, managed growth and enhanced competitive advantage.
• Attracts, coaches and develops talent within the Claims Department. Provides frequent and specific constructive feedback to staff. Provides technical advice, direction and mentoring to Claims staff. Facilitates the development and use of individual development plans to ensure ongoing professional development occurs within the organization.
• Ensures the team’s claims handling practices are compliant with all state statutes and regulatory/legal requirements.
• Communicates claim developments/trends to executive management and senior management team. Provides claims expertise including, but not limited to, claim developments and trends within Property and Casualty industry.
• Establishes and executes quality control process to ensure established Claims practices and procedures are being executed at the highest level.
• Assists in the management of the Claims Department budget and resources including explaining variances and related reporting.  Provides strategic input for the Companies 3-Year Business Plan and beyond.
• Interprets and ensures alignment with MMG’s vision as established by Executive Management. Creates actions and sets direction to meet expectations established.
• Communicates corporate culture and company philosophy to department staff and other entities.
• Communicates with other industry personnel to gain knowledge of marketplace trends to aid in the development of new products.
• Develops and maintains positive Company relationships with independent adjusting firms, independent attorneys, agents, and other entities, which may include travel, visitation and attendance at various conventions and meetings.  (May include overnight stays.)
• Travels as required to perform the essential duties and responsibilities of the employee's position and to fulfill educational requirements.  (May include overnight stays.)
• Other duties may be assigned.

SUPERVISORY RESPONSIBILITIES

Directs, mentors and trains department Managers, Assistant Managers, and/or Supervisor and is responsible for all members of the Claims staff.  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; performance appraisals; rewarding and disciplining employees; addressing complaints and resolving problems.

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

EDUCATION and/or EXPERIENCE

Bachelor’s degree and 15 or more years of progressively responsible experience in claims.

Previous leadership experience required, with an ability and passion for talent development.

LANGUAGE SKILLS

Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.  Writes clearly and informatively; Edits work for spelling and grammar; Able to read and to interpret written information.

MATHEMATICAL SKILLS

Ability to calculate figures and amounts such as discounts, proportions, percentages, and volume.  Ability to apply concepts of basic math.  Ability to interpret profit and loss statements and various other Internal Revenue Service documents in computing pecuniary loss.  Ability to understand structured settlement concepts and the ability to compute compound sums, present value and present value of an annuity.

Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

REASONING ABILITY

Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.

COMPUTER SKILLS

To perform this job successfully, an individual should have knowledge of Office Productivity software such as Spreadsheet, Word Processing, Communication software, and claims-related processing software.

CERTIFICATES, LICENSES, REGISTRATIONS

Possesses, or acquires, within a reasonable period of time as established by the Company, the required adjuster’s license(s) for the state(s) in which the Company does business.

The Company may expect the employee to acquire the Associate in Insurance Claims (AIC) designation sponsored by the Insurance Institute of America. 

The Company may expect the employee to take other courses it deems appropriate to the employee's job duties.

OTHER SKILLS AND ABILITIES

• Demonstrates leadership by exhibiting confidence in self and others; Inspires and motivates others to perform well; Effectively influences actions and opinions of others; Accepts feedback from others; Gives appropriate recognition to others.
• Demonstrates understanding of the organization’s goals and objectives and demonstrates ability to evolve as changes are implemented.
• Possesses above-average telephone skills.
• Possesses above-average interpersonal and relationship skills.
• Demonstrates excellent negotiating skills.
• Possesses the ability to professionally articulate a position/decision in an adversarial situation.
• Customer Service – Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Professionalism – Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Demonstrates the ability to consistently maintain a positive attitude.
• Works cooperatively and productively with employees.
• Is self-motivated with strong organizational skills.
• Demonstrates the ability to multi-task effectively and efficiently.

OTHER QUALIFICATIONS

Possesses a valid driver's license.

Able to travel 20-25% of the time

Teamwork – Balances team and individual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit.

Demonstrates an aptitude consistent with securing information, analyzing it, and making above-average decisions affecting the position's area of responsibility as well as the overall operation of the department.

Judgment – Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.

PHYSICAL DEMANDS 

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear.  The employee is occasionally required to stand, walk, reach with hands and arms, and climb or balance.  The employee must occasionally lift and/or move up to 25 pounds.  Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.

WORK ENVIRONMENT  

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally exposed to outside weather conditions.  The noise level in the work environment is usually quiet.