WHAT DOES A CLAIMS SUPERVISOR DO?
Published: July 15, 2024 - The Claims Supervisor oversees and trains adjusters to manage and resolve litigated Bodily Injury claims, ensuring quality outcomes through rigorous claim oversight and adherence to best practices and SHI requirements. This role involves auditing claims, directing adjuster actions for optimal file resolution, and promoting development and engagement among associates. Additionally, the supervisor collaborates on management projects, travels for legal proceedings, and leads internal operations to enhance efficiency and customer service while managing costs and spearheading process improvements.
A Review of Professional Skills and Functions for Claims Supervisor
1. Claims Supervisor Details
- Claims Inventory Management: Daily management of claims inventory and aging, customer service workflows/events, staff assignments, and priorities.
- Claims Personnel Training: Assist with hiring and training of claims personnel.
- Performance Management: Establish performance expectations, measure and communicate results, complete and deliver performance reviews, and manage corrective actions.
- Interdepartmental Coordination: Coordinate with Provider Relations, Provider Dispute Resolution, Appeals and Grievances, Configuration, Enrollment, and other functional areas.
- Claims Support: Support claims research, explanations, and reprocessing/adjustments.
- Team Mentorship: Support and mentor the team with their technical questions, complex claims, workflow management, and training needs.
- Claims Processing: Perform complex claims adjustments and claims processing.
- Audit Leadership: Lead, coordinate, support, and represent the claims team with health plan audits conducted by CMS, DMHC, TPA partners, and other external vendors.
- Policy Development: Manage development/improvement of policies and procedures, workflows, process flows, and job aids to enable compliant and accurate claims processing.
- Mail Management: Oversee the daily receipt, opening, stamping, sorting, scanning, and verifying of paper mail.
- Financial Coordination: Oversee and/or represent the claims team with check runs, finance department requests, EDI interfaces, EOB, and EOP fulfillment.
- Data Analysis: Analyze claims data to identify trends in processing errors, reasons for claims adjustments, training needs, and opportunities to automate and reduce cost.
- Project Leadership: Leads and contributes to special projects involving the claims team such as system implementations or upgrades, new claims programs and products, quality improvement, and other strategic initiatives.
2. Claims Supervisor Duties
- Performance Monitoring: Control, monitor and report Property Claim performance and results.
- Process Improvement: Address deficiencies in workflow and create or improve work processes.
- Compliance Monitoring: Monitor and ensure compliance with established Fair Claims Practices, State-specific statutes, rules and case law and claim handling guidelines.
- Trend Analysis and Corrective Action: Monitor performance for negative trends, and develop and implement corrective action.
- Regulatory Response: Research and respond to Department of Insurance inquiries.
- Personnel Management: Responsible for personnel administration including selection, salary, performance evaluation, staffing and planning.
- Employee Development: Ensure training, counseling, coaching and career development.
- Technical Supervision: Provide technical direction and authority on files as warranted.
- Objective Setting: Establish divisional performance objectives in coordination with and support of departmental and corporate goals.
- Management Communication: Support and communicate senior management initiatives, directives, corporate policies, plans and visions to associates.
- Technical Expertise Maintenance: Maintain a high level of technical expertise specific to the areas managed.
- Project Assistance: Assist the Director of Claims with special projects.
- Budget Management: Assist, review and approve the operating budget and expenses.
3. Claims Supervisor Responsibilities
- Team Supervision: Supervising a team of 6-8 claims representatives
- Claims Management: Provide direction, control, and guidance to claims staff in the investigation and conclusion of claims.
- Liability Analysis: Analyze investigative material for liability exposure, coverage, and damages to determine reserves and settlement values.
- Negotiation: Negotiate directly with the insured, claimants, or counsel in settling losses.
- Claims Processing: Assist set up unit in review of new claim reports and assigns to appropriate Claim Representative with handling instructions.
- Legal Coordination: Receive, evaluate, and assign to counsel suits commenced against the insured or the company.
- Investigation Guidance: Guide to counsel and coordinate any additional investigation required.
- Performance Recording: Maintain records of performance for Claims Representatives.
- Performance Review: Consult with the Branch Claim Manager on performance reviews and personally go through the review with each employee.
- Stakeholder Relations: Maintain relations with underwriters, auditors, marketing, and agents operating within the territory.
- Staff Development: Develop staff through education and ensure proper training of all employees.
- Cost Control: Control the cost of all outside and independent services.
4. Claims Supervisor Functions
- Supervisory Management: Supervises 3 to 6 claims bodily injury adjusters and/or examiners
- Personnel Development: Mentors, coaches, and trains personnel to achieve desired goals and position objectives utilizing department and individual metrics
- Claims Strategy Development: Proactively assesses claims processes and develops strategies to maintain or improve performance
- Performance Collaboration: Collaborates with employees individually and as a unit to promote accurate and ongoing performance feedback and promote career development
- Performance Evaluation: Conducts daily diary reviews to evaluate adjusters’ performance
- Technical Support for Reserves: Provides technical support for establishing appropriate reserves for new and ongoing claim investigations
- High Exposure Monitoring: Monitors claims that meet a high exposure loss profile
- Liability and Injury Resolution: Assists in the identification and resolution of liability determination and assessment of injuries
- Regulatory Compliance: Maintains compliance with the Department of Insurance and Company procedures
- Fraud and Correspondence Management: Responsible for the conclusion of correspondence and fraud cases
- Complex Claims Review: Reviews the more complex claims to ensure proper handling
- Authority in Claims Settlement: Settles claims over staff authority level.
5. Claims Supervisor Tasks
- Claims Supervision: Supervises, trains, coaches, and directs adjusters in resolving litigated Bodily Injury claims.
- Quality Assurance: Responsible for ensuring claim quality and desired outcomes through consistent oversight of claims.
- Claims Audit and Review: Audits and reviews files, directing adjusters toward appropriate file resolution while reinforcing best practices and SHI requirements.
- Associate Development: Promotes associate development and engagement.
- Management Collaboration: Collaborates with other members of the management team on various projects and assignments.
- Ad Hoc Duties: May be called upon to perform additional duties as directed.
- Client Relationship Management: Builds strong rapport with clients, understanding their needs and guiding the handling of their claims.
- Legal Support Travel: Travels for participation at trials and mediations.
- Operations Supervision: Supervises internal operations to achieve high efficiency and customer service while effectively controlling costs and managing process improvement initiatives.
- Claims Processing Oversight: Responsible for claims processing and loss control efforts.
- Claims Guidance: Provides direction on claim investigation, decision-making, and documentation.