Sr. Claims Manager – Workpartners

UPMC Health Plan and Workpartners is hiring a Senior Claims Manager. This role may work remotely but preference will be given to those located in Pennsylvania. This position may occasionally involve travel for conferences or client meetings.

The Sr. Claims Manager is responsible for management of the claims office. This includes claims management, sales, account servicing, legislative activities and making sure the office is in compliance with state requirements. The Sr. Claims Manager is responsible for hiring, training and evaluating team members. This role provides coaching and mentoring to team members to enhance performance and development and promote team building; and identifies additional training needs and monitors performance against established metrics. This position has internal relationships with various UPMC departments including, but not limited to: Account Management, Sales, Risk Control, Finance, Actuarial and Information Technology. External relationships include, Clients, Service Providers, Attorneys and Judicial Bodies, State Regulatory Agencies, and Claims organizations. The Sr. Claims Manager has financial authority for the local office expenses within budgeted approval and appropriate reserving of the claims files. Decision-making authority includes: personnel authority as delegated by the President of Work Partners including salary reviews, performance reviews and workload distribution, settlement and acceptance authority on claims up to established authority.

Responsibilities:

• Summarize results, identify opportunities for efficiencies and improvements in order to make recommendations and communicate key messages to branch team and senior management.
• Develop and maintain working relationships with external vendors. Negotiate annual billing rates.
• Will take appropriate steps to ensure standards for quality/quantity are delivered allowing the company to meet its service commitments. As such, must be effectively delegate work and motivate staff to ensure that the necessary time is available to meet all management responsibilities.
• Coordinate and participate in meaningful claims reviews with clients as requested by the President of WKP, Brokers or Agents.
• Reviews reserve amounts on high-cost/sensitive claims and claims over the authority of the Claims Supervisor and adjusters.
• Provide operational support, supervision and evaluation for the claims units. This support extends to Supervisors, Claims Examiners, Claims Technicians, Claims Clerks and Office personnel. Day-to-day and global issues impacting the office, staff and program management are addressed.
• Keep senior management abreast of developments within the operation and provide support for management on special projects.
• Provide Management Oversight and direction to the claim units in the adjudication of workers compensation claims
• Attend seminars/training for self-development, management and Disability Management.
• Responsible for filling the employment needs of the office and that applicable employment criteria are met. Ensure that appropriate policies are followed and that new hire’s transition into the company is a smooth one.
• Work closely with Manager of Network Services and Medical Delivery Coordinator in expanding provider network.
• Responsible for identifying training needs of existing staff and new hires and develop and implement training programs enhancing the staff’s technical expertise as it relates to new products, systems, service interfaces and treatment protocols.
• Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.
• Understand the job duties of each staff member, while appreciating the diversity of staff and how it relates to the operation of the department.
• Complete assignments/projects as indicated by the President of WKP efficiently, timely and without reminders.
• Develop, evaluate and implement all claims management policies/protocols/procedures in compliance with appropriate regulations for UPMC Work Partners and its clients, while meeting Work Partners service standards and state laws.
• Provide the necessary support and direction for company projects, goals, and time schedules. Responsible for setting and meeting annual goals established for the office and for meeting those goals on a timely basis.
• Provide assistance and oversight of workers’ compensation panel development and utilization.
• Monitor personnel and operation performance, and take the necessary steps to improve and streamline the office to allow for profitable growth of the division.
• Must possess a thorough understanding of all products and services sold by the company and their impact/relationship on the office and technological support systems.
• Engage in external discussions to solicit feedback for continued improvement of the Commercial Claims Department. Focus on appropriate implementation to improve operational efficiencies.
• Effectively manage high-cost/sensitive claims and settlements.
• Must possess a thorough understanding of the company’s policies and practices. Must be able to deal with both management and personnel problems in a sensitive and tactful manner, effectively coordinating and resolving problems, and conflicts, or potential problems ensuring effective operation of the office.
• Work with the organization to collect data, map critical processes and evaluate branch initiatives.
• Work with President of WKP to develop, monitor and measure the effectiveness of cost containment strategies.