Job Summary:

• Lead a multiple functional organization with competing demands
• Establish objectives and plans for the organization’s operations
• Build and implement operational processes and teams
• Write reports, business correspondence, and procedures
• Interpret reporting requirements and report to clients all customer support activities in as glowing terms as and where possible
• Effectively present information and respond to questions for groups of managers, customers, providers, investigative agencies, and the general public
• Define problems, collect data, establish facts, and reach conclusions
• Use software applications ability to evaluate the performance of subordinates
• Understand and evaluate ownership concepts
• Understand Medicaid procedures and policies
• Work in the best interest of the company as a whole (i.e., team player) and not protect territory
• Effectively motivate performance and manage workflow in an operations and production environment with established quality and quantity standards.
• Understand claims processing in an automated environment

Skills on Resume:

• Strategic Leadership (Soft Skills)
• Process Implementation (Hard Skills)
• Advanced Reporting (Hard Skills)
• Effective Presentation (Soft Skills)
• Problem-Solving (Soft Skills)
• Software Proficiency (Hard Skills)
• Regulatory Knowledge (Hard Skills)
• Team Motivation (Soft Skills)

Job Summary:

• Manage and provide technical guidance to the Risk Analyst(s) on WC claims
• Direct and coordinate the activities of AB’s 3rd-party claim administrators (“TPA’s”) and other external claim professionals
• Assure TPA’s act by service instructions. 
• Manage all issues relating to TPA and adjuster turnover
• Lead and coordinate the activities of AB operations personnel, HR, TPA’s and claimants to assure beneficial outcomes (e.g. claim reporting, return–to–work procedures, etc.)
• Conduct annual claim reviews with insurers and TPAs to ensure case reserves are adequate, adjusters are performing within guidelines and best practices
• Attend and represent AB at mediations, settlement conferences and/or hearings and appropriate
• Develop internal training procedures and programs to manage claim costs and reduce losses (loss control programs)
• Complete all self-insurance reports, audits and related regulatory submissions
• Approve all settlement requests and escalate for justification and additional approvals according to AB Risk Management procedures
• Manage and provide technical guidance to the Risk Analyst(s) on claims issues
• Manage claim service for all serious claims and oversee case management activities to a conclusion

Skills on Resume:

• Technical Guidance (Hard Skills)
• TPA Coordination (Hard Skills)
• Compliance Assurance (Hard Skills)
• Turnover Management (Soft Skills)
• Operational Leadership (Soft Skills)
• Claims Review (Hard Skills)
• Legal Representation (Hard Skills)
• Training Development (Hard Skills)

Job Summary:

• Prepare settlement authorization, participate in settlement discussions, and attend mediations, hearings and trials
• Coordinate activities among the Risk Management Department, AB Legal Department and insurer’s claim professionals
• Manage all EEOC claims and bordereau reporting. 
• Coordinate activities between AB Legal (HR Counsel) and insurer claim and legal professionals
• Oversee and manage all dispensing and medical/pharmacy professional claims with AB’s TPA
• Coordinate with AB Legal on all issues, including strategy, defense and settlement
• Manage and oversee all minor property and cargo claims
• Manage and oversee TPA relationship with AB’s cargo claim TPA
• Review and approve state self-insurance filings and other regulatory reports.
• Complete all subpoena requests as necessary
• Develop, implement and manage claim reports for use by RMD and other AB entities.
• Analyze claims data for trends, ensure the accuracy of reserves and escalate
• Assist and support the insurance renewal process concerning claims
• Establish and maintain a catalog of AB’s international travelers

Skills on Resume:

• Settlement Oversight (Hard Skills)
• Department Coordination (Soft Skills)
• Claims Management (Hard Skills)
• Legal Strategy Coordination (Hard Skills)
• TPA Oversight (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Claims Reporting (Hard Skills)
• Data Analysis (Hard Skills)

Job Summary:

• Coordinate with Strategic Global Sourcing to ensure that AB’s international travelers are appropriately informed of travel risks and related resources
• Provide annual reporting data to support the International SOS renewal process
• Collaborates with other members of the Risk Management Department to support the overall department goals and objectives
• Handle personnel issues relating to staff conflicts, absenteeism, performance issues, etc.
• Work with each direct report to establish goals and objectives for each year
• Monitor and advise on progress to support the professional development of staff
• Provide training to new and existing staff 
• Compile all necessary reports for the Director of Risk Management for quarterly financial obligations
• Comply with all applicable ABC policies and procedures
• Prepare performance evaluations, goal setting and performance management reviews following corporate policies and applicable laws.
• Deliver, set action plans and follow up with appropriate individuals.
• Promote and maintain a team environment.
• Monitor team attendance according to departmental standards.

Skills on Resume:

• Strategic Coordination (Hard Skills)
• Data Reporting (Hard Skills)
• Team Collaboration (Soft Skills)
• Conflict Management (Soft Skills)
• Goal Setting (Soft Skills)
• Staff Development (Soft Skills)
• Training Delivery (Hard Skills)
• Performance Management (Soft Skills)

Job Summary:

• Manage the workflow of the teams and evenly distribute and reassign tasks
• Ensure client Service Levels and Quality Standards are met by monitoring daily and monthly activity reports.
• Ensure benefits and escalations are processed correctly, according to client/AIM rules and procedures.
• Identify performance trends and patterns and make recommendations
• Identify opportunities to enhance the customer or colleague experience through surveilling customer interactions and transactions and managing exceptions
• Provide support to Benefit and Resolution Analysts by reviewing complicated benefit and escalation situations and/or assisting with challenging customer situations
• Identify and address any processing or technical issues impacting the Analysts or the overall BARS department.
• Provide direction and input on system updates and management reporting/analytics.
• Support client and internal projects
• Assist/support system functionality, including user testing and serving as a subject matter expert.
• Provide clear, detailed and timely communication (i.e. internal memos, team alerts, etc.) to the team outlining any changes to client or internal processes, procedures or rules.
• Work with the Operations team to ensure the appropriate reference documents (SOP manuals, etc.) updated

Skills on Resume:

• Workflow Management (Hard Skills)
• Quality Assurance (Hard Skills)
• Performance Analysis (Hard Skills)
• Experience Enhancement (Soft Skills)
• Analytical Support (Hard Skills)
• Technical Troubleshooting (Hard Skills)
• System Guidance (Hard Skills)
• Communications Management (Soft Skills)

Job Summary:

• Manage, coach and develop the Benefit and Resolution Analysts. 
• Work with Human Resources, Quality Assurance and Management team to address performance and/or quality issues.
• Evaluate team members for assignments and advancements.
• Identify performance trends and patterns and coach the Benefit and Resolution Analysts accordingly.
• Hold regularly scheduled meetings with the team and each team member to provide updates and review performance, progress on goals, and issues.
• Focus on both employee development and team-building initiatives.
• Responsible for the interviewing and hiring process.
• Maintain strong internal controls and work with auditing teams (internal and external) to meet client and Gainwell Technologies requirements
• Meet a plethora of corporate leadership requirements on personnel, budgets, and processes
• Maintain staffing levels as budgeted and fill billable direct positions quickly
• Maintain high energy level under heavy loads or high levels of stress
• Work and coordinate with the insurance underwriter on insured claims
• Interacts with customers to assist them with the Claims process

Skills on Resume:

• Team Management (Soft Skills)
• Performance Evaluation (Hard Skills)
• Employee Coaching (Soft Skills)
• Team Meetings (Soft Skills)
• Hiring Process (Hard Skills)
• Audit Collaboration (Hard Skills)
• Leadership Requirements (Soft Skills)
• Customer Interaction (Soft Skills)

Job Summary:

• Research leads, develop entrance strategies and qualify prospects' transportation spend to generate new business
• Manage the Company’s exposure to risk by ensuring all claims are thoroughly examined and investigated to minimize financial loss while ensuring the Company’s, local, state and federal regulations are met
• Assess liability to apportion damages based on a percentage of negligence for negotiating settlements with claimants, attorneys and insurance companies
• Ensure compliance with the Carmack Amendment, IATA and COGSA
• Develop, recommend and initiate prevention policies and procedures
• Maintain and monitor case files daily to determine if reserves are set accurately, adjusting within the authority limits
• Provide management and leadership to a support team, coach, lead and develop
• Support and assist field operational personnel in handling all shortages and damages
• Provide weekly reporting to all levels of management
• Manage the first line of communication and follow up correspondence /communication with claimants, insurance companies and attorneys regarding claims.
• Assess liability and process subrogation with partners and settlements with claimants.
• Ensure quality management of claims by best practices
• Develop and implement strategic metrics to assess the performance of the claims program

Skills on Resume:

• Lead Generation (Hard Skills)
• Risk Management (Hard Skills)
• Liability Assessment (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Policy Development (Hard Skills)
• Case Monitoring (Hard Skills)
• Team Leadership (Soft Skills)
• Strategic Reporting (Hard Skills)

Job Summary:

• Taking ownership of claims and managing a portfolio in conjunction with the Internal and External Assessing team.
• Case management of claims to provide support to customers within policy entitlements, organization of repairs & management throughout the claims life.
• Being the primary point of contact for customers who have experienced loss or damage to their property, and proactively providing progress updates as to claim progression.
• Meeting Key Results Areas, which are in line with overall business objectives
• Work with Executive Management, Director of Risk and Compliance and local station management to identify root causes of damage and assist with suggestions and plans to eliminate non-conformance.
• Interact with customers and field team members in corrective action to reduce, minimize and/or eliminate claims
• Guide, train, teach and support all levels of field personnel on functions and procedures designed to reduce exposure to lost freight claims
• Manages a team of Financial Institutions and Commercial Institutions' claims handlers.
• Responsible for the FI/CI team’s performance against KPIs.
• Works closely with the Specialty Claims Director and US referral matrix to ensure appropriate escalation, review and management of large and clash losses on the FI and CI portfolios.
• Discusses analysis of expert reviews and various pathways to claim resolution.

Skills on Resume:

• Claims Ownership (Hard Skills)
• Case Management (Hard Skills)
• Customer Communication (Soft Skills)
• Performance Metrics (Hard Skills)
• Root Cause Analysis (Hard Skills)
• Claims Reduction Strategy (Hard Skills)
• Team Leadership (Soft Skills)
• Claims Resolution (Hard Skills)

Job Summary:

• Responsible for quality and performance metrics of the processing team and performance management
• Manage claims projects as assigned by the claims director
• Draft and maintain documentation, including policies & procedures, workflows about claims operations, and encounter data collection and submission
• Ensure that claims payment system data and processes are properly maintained and up to date, such as fee schedules or provider billing information
• Responsible for reporting developments and trends in the wider legal and regulatory environment applicable to the FI/CI portfolios.
• May handle a limited caseload of high-value and/or complex FI/CI claims as necessary.
• Manage a team of claim associates who handle auto bodily injury, UM, UIM, and General Liability claims. 
• Oversee the investigation and settlement of all claims assigned to the team. 
• Provide advice and direction to claim associates. 
• Responsible for the selection, training, development and performance of personnel as well as performance reviews, salary adjustments and promotions. 
• Attend weekly category cross-team meetings with senior managers to represent CSI issues and opinions. 
• Attend senior management reviews to provide testing and standards insight and to challenge their opinion/suggestions.

Skills on Resume:

• Performance Metrics Management (Hard Skills)
• Claims Project Management (Hard Skills)
• Documentation Drafting (Hard Skills)
• System Maintenance (Hard Skills)
• Regulatory Reporting (Hard Skills)
• Claims Handling (Hard Skills)
• Team Leadership (Soft Skills)
• Stakeholder Engagement (Soft Skills)

Job Summary:

• Utilizes risk investigations and expert reviews to evaluate legal liability and causation to set financial reserves, evaluate claim values, and negotiate and resolve claims when indicated or to determine to litigate the matter to and through trial 
• Assign appropriate defense counsel depending on venue, claim type, and potential claim value. 
• Works extensively with outside defense counsel to manage and resolve claims. 
• Also works with defense counsel to determine whether to take a case to trial versus offer resolution based on department guidelines.
• Works in conjunction with defense counsel to select the appropriate medical experts by specialty to review cases and provide an opinion on the standard of care and causation
• Ensures accurate billing of outside defense counsel through extensive review of defense bills utilizing bill review software and department guidelines to ensure compliance.
• Conducts appropriate insurance coverage analysis for various lines of coverage on each liability claim. 
• Works closely with insurance staff when coverage issues arise.
• Works closely with Loss Prevention to identify potential claims that would qualify for the Early Liability Review Program. 
• Monitoring defense counsels’ response for timely expert evaluation and notification to the claims and loss prevention team.
• Sets accurate financial reserves based on experience and reserving formula promptly.

Skills on Resume:

• Risk Evaluation (Hard Skills)
• Counsel Assignment (Hard Skills)
• Claims Management (Hard Skills)
• Expert Collaboration (Hard Skills)
• Billing Oversight (Hard Skills)
• Coverage Analysis (Hard Skills)
• Preventative Monitoring (Hard Skills)
• Financial Reserving (Hard Skills)

Job Summary:

• Works closely with market and group senior leaders to explain the evaluation of risks and alternatives for resolution or litigation regarding various claims.
• Works closely with employed physicians to explain the claims and litigation process when the physicians are named in a lawsuit. 
• Represent as an expert technical witness in court or depositions.
• Horizon-scan for opportunities for new endorsement partners/schemes or product advocates.
• Identify credible partners and develop scheme structure, negotiate costs, and build in stretching targets to ideally secure exclusivity for Dyson. 
• Developing and maintaining key stakeholder relationships
• Development and implementation of effective operational procedure
• Adherence to business standards
• Handling claims within a delegated authority framework
• Managing an effective license-controlled claims environment
• Managing adherence to agreed SLAs in a technical handling environment
• Technical competency in the key delegates' authority areas

Skills on Resume:

• Risk Communication (Soft Skills)
• Physician Support (Soft Skills)
• Expert Testimony (Hard Skills)
• Partnership Development (Hard Skills)
• Stakeholder Relations (Soft Skills)
• Operational Development (Hard Skills)
• SLA Management (Hard Skills)
• Technical Competency (Hard Skills)

Job Summary:

• Works closely with the Risk management related to claim investigations, legal discovery of information, evaluation of claim value, and management of the litigation and resolution process.
• Maintains a diary system to track claim progression from report through investigation, evaluation, discovery, and analysis.
• Responsible for obtaining defense counsel reports promptly and directing litigation efforts by department guidelines.
• Manages a team of Casualty claims handlers.
• Responsible for the Casualty team’s performance against KPIs.
• Works closely with the Commercial Claims Director and US referral matrix to ensure appropriate escalation, review and management of large and clash losses on the Casualty portfolios.
• Responsible for reporting developments and trends in the wider legal and regulatory environment applicable to the Casualty portfolios.
• May handle a limited caseload of high-value and/or complexity Casualty claims
• Identify and commission external test houses capable of running standard tests and bespoke methods as new product categories come online.
• Develop working practices, including job tracking and test scheduling and ensure timely, cost-effective and accurate delivery of reports. 
• Attend calls and meetings with external legal counsel to explain complex detail technologies
• Test methods and comparative data that support claims before launch or in defense of challenges.

Skills on Resume:

• Claims Investigation Management (Hard Skills)
• Diary System Maintenance (Hard Skills)
• Litigation Direction (Hard Skills)
• Team Performance Management (Soft Skills)
• Claims Escalation Oversight (Hard Skills)
• Regulatory Reporting (Hard Skills)
• External Testing Coordination (Hard Skills)
• Methodology Development (Hard Skills)

Job Summary:

• Ensuring robust, durable substantiation is in place makes the company a performance statement to the wider world.
• Analyzing and presenting data, explaining technical detail to non-technical audiences
• Working with RDD and legal to develop appropriate test methods and capability within and outside
• Conceiving and executing novel research with contract and academic partners to evidence new claim avenues.
• Keeping out of court by treading the line between compelling claims that sell products and having persuasive, comprehensive data to support advertising.
• Be responsible for all claims, methods, testing and evidence for one or more product categories. 
• Build expertise in those categories, and know the technology.
• Develop the claim substantiation strategy for each project from early milestones and work with RDD to tune product specs and validate suitable test methods.
• Represent at International Standards working groups such as IEC or ASTM.
• Formulate and agree on position on individual issues. 
• Use RDD resources to generate data for meetings to qualify position. 
• Assist local markets in designing region-specific research with local partner organizations to facilitate new product endorsement/advocacy or novel claims.

Skills on Resume:

• Claim Substantiation (Hard Skills)
• Data Analysis & Presentation (Hard Skills)
• Test Method Development (Hard Skills)
• Research Execution (Hard Skills)
• Claims Management (Hard Skills)
• Technical Expertise Development (Hard Skills)
• Standards Representation (Hard Skills)
• Regional Research Design (Hard Skills)

Job Summary:

• Ensuring effective and economic resolution of all claims handled within the AIUA and BIBU claims teams within the awarded delegated authorities
• Team leadership and daily management responsibilities
• Team member performance management
• Appraising and developing staff to ensure that the team is resourced with well-motivated and capable individuals
• Recruitment and Induction group claims contact
• Workflow and operational process
• KPI and MI production and utilization, monitoring results and identifying underlying trends
• Broker relationships, third-party relationships and performance management
• Ensuring all relevant changes in response to changes in regulation, legislation, market conditions, or business philosophy are effectively implemented
• Delegated Authority management and delivery
• Claims Strategy - Design and Implementation
• Complete Internal and external audits
• Technical delivery and process
• Handle Complaints and technical referrals
• Handling delegated authority claims end-to-end

Skills on Resume:

• Claims Resolution Management (Hard Skills)
• Team Leadership (Soft Skills)
• Performance Management (Soft Skills)
• Staff Development (Soft Skills)
• Process Optimization (Hard Skills)
• Relationship Management (Soft Skills)
• Regulatory Compliance (Hard Skills)
• Claims Strategy Implementation (Hard Skills)

Job Summary:

• Working as part of the expert regional claims team, responsible for regional claims assessment ( France and Continental Europe)
• The assessment of complex Life, Disability, Income Protection and Cash Hospitalization, primarily in France & Europe (but also beyond).
• Sharing expertise with colleagues, maintaining department productivity, quality and turn-around-time standards
• Working closely with account managers, build and maintain proactive and positive working relationships with life insurer clients and brokers
• Work in collaboration with colleagues in many other fields of the business, for example with other claims professionals, medical advisors, client managers, pricing actuaries, legal teams etc...
• Carry out on-site and virtual client claims auditing and process reviews (as part of a team).
• Key claims and process evaluation and input in market tenders and product development
• Input and contribution to claims approach/philosophy and processes
• Engagement in projects and process improvement initiatives
• Define technical specifications for developers and administrators and are also a sought-after contact person internally.
• Actively involved in the implementation of innovative projects for digital claims management and contributed significantly to the fulfillment of ambitious goals.

Skills on Resume:

• Claims Assessment Expertise (Hard Skills)
• Interdepartmental Collaboration (Soft Skills)
• Client Relationship Management (Soft Skills)
• Claims Auditing Skills (Hard Skills)
• Market Strategy Input (Hard Skills)
• Process Improvement Leadership (Soft Skills)
• Technical Specification Development (Hard Skills)
• Digital Claims Innovation (Hard Skills)

Job Summary:

• Responsible for the management of a portfolio of approx. 290 claims as assigned by the Senior Claims Manager GIS.
• Responsible for the investigation and evaluation of each claim assigned and for recommending the resolution strategy and implementation of such.
• Liaise with external professionals (e.g., solicitors, barristers, experts, doctors)  to seek guidance on the course of action that is in the best interest of the State authority.
• Selects solicitors & barristers (from panels) and experts for cases and attends meetings where appropriate with the relevant State authority.
• Responsible for ensuring timely processing of all claims, and ensuring paper and online documentation is accurate.
• Acts as a daily contact for State authorities to provide advice and guidance on issues pertinent to employers or public liability claims.
• Allocate work as appropriate to administrators but with no supervisory responsibilities.
• Responsible for the expansion and further development of claims management.
• Develop the best claims processes for customers, taking into account business efficiency.
• Control, manage and check external service providers.
• Coach commercial managers in local advertising law requirements, and limitations and constraints on substantiation and subsequent claim language. 

Skills on Resume:

• Claims Portfolio Management (Hard Skills)
• Claim Investigation Expertise (Hard Skills)
• Professional Liaison (Soft Skills)
• Legal Representative Selection (Hard Skills)
• Documentation Accuracy (Hard Skills)
• Authority Advisory Role (Soft Skills)
• Process Optimization (Hard Skills)
• External Provider Oversight (Hard Skills)

Job Summary:

• Investigate potential claims, claims, and lawsuits.
• Determines information and documents required to fully assess liability, and damages.
• Works directly with unrepresented patients and families to gather information and resolve claims.
• Participates in the Communication and Resolution Program by identifying appropriate cases and helping to guide disclosure conversations.
• Retains outside counsel to represent MultiCare and works with counsel to respond to discovery and develop litigation and/or settlement strategy.
• Maintains a diary system on assigned cases to ensure deadlines are met and cases are constantly moving forward to resolution.
• Documents conversations in the claims database and uploads correspondence and legal documents to the claims file.
• Attend trials, mediations, and key depositions.
• Evaluate claims and lawsuits and set appropriate expense and indemnity reserves.
• Updates the reserves when necessitated by discovery responses or expert opinions or increasing expenses.
• Negotiates settlements and authorizes payments.
• Selects appropriate expert witnesses to support claims against MultiCare
• Reviews and approves outside counsel invoices and expenses related to investigation and defense of claims and lawsuits.

Skills on Resume:

• Claims Investigation (Hard Skills)
• Liability Assessment (Hard Skills)
• Patient Communication (Soft Skills)
• Disclosure Guidance (Soft Skills)
• Legal Strategy Development (Hard Skills)
• Case Management (Hard Skills)
• Settlement Negotiation (Hard Skills)
• Expert Witness Selection (Hard Skills)

Job Summary:

• Managing property claims arising out of losses covered by reinsurance agreements
• Legal analysis of contract wording, verifying coverage under reinsurance policies and authorizing payments
• Investigating and implementing loss mitigation potentials with the help of internal and external experts
• Directly interacting with cedents and brokers regarding coverage and indemnification
• Managing significant loss events (e.g. large natural catastrophes)
• Participating in internal claims and external cedent reviews
• Providing feedback to underwriters regarding claims
• Develop, monitor, and report a departmental budget.
• Perform other related duties as assigned or requested.
• Provide management with feedback regarding departmental functions.
• Interact with internal departments to correct procedural and system problems.
• Monitor productivity and accuracy of unit staff as they adjudicate, adjust, perform analysis and research claim projects.
• Actively participate in the recruitment and hiring of claims staff.

Skills on Resume:

• Claims Management (Hard Skills)
• Legal Analysis (Hard Skills)
• Loss Mitigation (Hard Skills)
• Broker Interaction (Soft Skills)
• Event Management (Hard Skills)
• Claims Review (Soft Skills)
• Budget Oversight (Hard Skills)
• Staff Recruitment (Soft Skills)