Manager, Claims (Medpay/PIP)
American National is seeking a Claims Manager to join our dynamic MedPay/PIP team. The role is responsible for the direct oversight of a team of first party injury Claims Specialists of varying experience in handling first party injury claims in multiple jurisdictions and is pivotal in the support and development of exceptional claims handling standards and customer service.
What will you do?
o Lead and manage the claims team in aspects of claim handling, including coverage, processing, and paying medical bills appropriately. Providing effective claim management including file reviews, coverage analysis, and decision making.
o Monitor expense management and the approval of claim payments, including reviewing payments to ensure timely and issued within state regulation timeframes.
o Adhere to, promote company policies, and drive claims handling best practices in accordance with Best Practices.
o Champion exceptional customer service standards.
o Support professional written correspondence regarding various aspects of the claim, including sending medical authorization(s), attorney acknowledgement(s), delay/verification request(s), and denials.
o Ensure compliance with state regulations and statues along with delaying, denying, and/or paying billing appropriately.
o Provide ongoing training, coaching and direction as needed to achieve target claim outcomes and company goals. Oversee all aspects of talent management including selection/hiring, retention, and performance management.
o Spot check file review on open and closed claims along with validation of audits completed by the QI Department.
o Create and promote a positive work environment, while fostering a culture of teamwork and accountability.
o Partner in process development and improvement across all areas of the claims department, as well as participate in various projects contributing to claims strategy.
Required Qualifications:
o Five years of MedPay/PIP claims handling experience in a multi-jurisdiction setting. Knowledge of insurance coverages, claims processes, and industry regulations.
o Highly motivated team player.
o Excellent interpersonal and leadership skills, and ability to collaborate effectively with both internal and external partners.
o Excellent written and verbal communication skills, as well as high attention to detail and follow-up.
o Currently hold an appropriate state adjuster license or willingness to obtain following date of hire (American National will incur fees associated/No out of pocket expense).
o High School diploma or equivalent
Preferred Qualifications:
o Mitchell Platform (bill review vendor) experience.
o Prior Management experience and/or mentor/training experience.
o Bachelor’s degree in a related field; advanced degrees or certifications (e.g., AIC, CPCU).
o Technical skill set in Guidewire or alike claims management system.
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