Medical Claims Review Manager jobs in Saint Louis, MO

Claims Manager

This position is based in our ArchKey/Sachs Electric office in St. Louis, MO

About the company

ArchKey Solutions is a Top 10 National Electrical Contracting company. Our teams work on large, sophisticated projects across the United States. When you work with ArchKey or any of our regional divisions, you join an expansive network of resources, experts, and innovators. More than a bright future, ArchKey Solutions offers positions with a stellar today. We are a lifestyle employer, providing flexibility, great pay, and strong benefits allowing you to live your best life at and away from work.

About the position

Responsible for the development and implementation of a thorough, practical, and effective claims management program at the Company. This position provides incident investigation and claims management support across the ArchKey platform under the guidance of the Company's mission statement, corporate vision, and code of conduct/ethical business practices, and in alignment with all Company policies, procedures, key objectives and regulations..

Day in the life

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

• Analyzes incidents to determine the necessity of reporting claims to carriers or retaining claims as part of the Company's 'self-handling' protocol. Communicates directly with risk management leadership before remitting claims to insurance carriers.
• Conducts thorough claim investigations, monitors medical reports, partners with claims adjusters and legal counsel to resolve claims, and makes quality recommendations regarding claims handling for successful claims resolution.
• Authorizes settlements, compromises, and pays claims up to $25,000. Attends regular meetings to update and discuss status of open claims and action plans for closure.
• Oversees the implementation and utilization of the Risk Management Information System (RMIS) to assure that all incidents are captured, reported, and the financial information is current and accurate.
• Manages third-party medical bill audits for all self-handled medical expenses. Generates reports for claim activities and costs. Accurately and confidentially maintains Company claim records and other sensitive employee data.
• Assists with prompt medical care for occupational injuries, monitors ongoing medical treatments, procures appropriate restrictions, and assists in identifying light duty or alternate work options for employees' successful return to work.
• Collaborates with safety team on all incidents and investigations and coordinates with safety leadership regarding claims data, analytics and trends identified for use in preventive measures, incident investigations and crisis management.

• Develops and maintains strong, positive working relationships with all stakeholders and communicates professionally with internal and external customers.
• Maintains professional and technical knowledge by attending education workshops, reviewing professional publications, establishing personal networks, and participating in professional societies relevant to the industry.
• Maintains compliance with all federal, state, and local laws and regulations.
• Promotes and models the Company mission, vision and values through exercising sound and ethical business practices, championing all elements of diversity, equity, and inclusion (DEI) and providing high quality services and programs as they relate to clients, subcontractors, co-workers, suppliers, and the public.

Minimum Qualifications

Required Education, Experience and Skills

• Bachelor's Degree or equivalent work experience in risk management, insurance claims management, safety, construction management or a related field.
• Associate in Risk Management (ARM) Certification or equivalent training in the insurance industry.
• Minimum 5-7 years of experience with claims processing and claims management, preferably in the electrical construction industry.
• Keen knowledge of construction & general industry safety standards, including OSHA, MSHA, DOT & NFPA 70E.
• Strong business analysis and mathematical skills. Skills to read and interpret financial documents.
• Superior listening, presentation, negotiation, conflict management and persuasion skills, and the ability to influence employees at all levels, including senior management.
• Effective organizational, complex problem solving and time management skills.
• Demonstrated ability to diagnose problems with strategic thinking skills and detail orientation, and to drive timely and appropriate solutions across all business lines with self-initiative and sensitivity.
• Excellent written and verbal communication skills, including high quality documentation and report preparation.
• Demonstrated high level of integrity and dependability.

ArchKey Solutions is an Affirmative Action, Equal Opportunity Employer: M/W/Vets/Disabilities.

Our commitment to Diversity, Equity and Inclusion is an important aspect of our culture.

Every person is welcomed Every person is included Every person is valued