Director, Claims Appeals

Combined Insurance a Chubb Company is seeking aDirector Claims Appealsfor operations to join our fast-paced high energy growing are proud of our tradition of success in the insurance industry of over 100 years. Come join our team of hard-working talented professionals!

JOB SUMMARY

The Director Claims Appeals is responsible for leading and managing the claims appeals department ensuring efficient and effective processing of appeals related to claims and confirming compliance with regulatory standards including the Employee Retirement Income Security Act (ERISA) of 1974. This role involves strategic planning team leadership and collaboration with other departments such as Claims Legal and Compliance to optimize the appeals process and improve outcomes. The director will guide the development and effectiveness of the team by advocating a climate of collaboration ownership and accountability and work to maintain a level of excellence in the overall performance of the team.

RESPONSIBILITIES

• Serve as chief liaison for Claims Appeals activities.
• Develop and implement strategic plans to improve the efficiency and effectiveness of the claims appeals process.
• Lead mentor and manage a team of claims appeals specialists providing guidance and support to achieve departmental goals.
• Oversee the review and analysis of claims ensuring accurate and timely processing of appeals.
• Review and approve claims appeals decisions.
• Establish and maintain relationships with Claims Legal healthcare providers and other stakeholders to facilitate the resolution of claims disputes.
• Monitor industry trends and regulatory changes to ensure compliance and adapt strategies accordingly.
• Analyze data and metrics to identify areas for improvement and implement process enhancements.
• Create and maintain accurate and comprehensive tracking around appeals volume and handling status.
• Engage team via coaching and mentoring to maintain culture of continuous improvement.
• Address complex claim issues and develop cross-functional solutions partnering with stakeholders when needed.
• Build a knowledgeable empowered and self-driven team to inspire confidence inside and outside the department.
• Sets team goals and objectives monitors performance and develops and maintains a team focused on excellence.
• Ensure efficient allocation of resources and adherence to budget.
• Foster a culture of continuous improvement and professional development within the team.
• Provide input and make decisions on policies systems methods and procedures for the effective management and control of the Claims Appeals functions.
• Maintain current knowledge of client needs products and insurance industry.
• Ensure incorporation of Compliances interpretation of regulations and laws into Claims processes in a user-friendly way.
• Perform other duties as assigned.

COMPETENCIES

• Problem Solving:Takes an organized and logical approach to thinking through problems and complex issues.Simplifies complexity by breaking down issues into manageable parts.Looks beyond the obvious to get at root causes.Develops insight into problems issues and situation.

• Continuous Learning:Demonstrates a desire and capacity to expand expertise develop new skills and grow professionally.Seeks and takes ownership of opportunities to learn acquire new knowledge and deepen technical expertise.Takes advantage of formal and informal developmental opportunities.Takes on challenging work assignments that lead to professional growth

• Initiative:Willingly does more than is required or expected in the job.Meets objectives on time with minimal supervision.Eager and willing to go the extra mile in terms of time and effort. Is self-motivated and seizes opportunities to make a difference.

• Adaptability:Ability to re-direct personal efforts in response to changing circumstances.Is receptive to new ideas and new ways of doing things.Effectively prioritizes according to competing demands and shifting objectives.Can navigate through uncertainty and knows when to change course

• Results Orientation:Effectively executes on plans drives for results and takes accountability for outcomes.Perseveres and does not give up easily in challenging situations. Recognizes and capitalizes on opportunities.Takes full accountability for achieving (or failing to achieve) desired results

• Values Orientation:Upholds and models Chubb values and always does the right thing for the company colleagues and customers.Is direct truthful and trusted by others.Acts as a team player.Acts ethically and maintains a high level of professional integrity.Fosters high collaboration within own team and across the company; constantly acts and thinks OneChubb

SKILLS

• Significant experience working with claims and claimants.
• Excellent verbal and written interpersonal and communication skills.
• Strong understanding of insurance policies and medical records.
• Excellent analytical and problem-solving skills.
• Ability to work independently and manage multiple tasks effectively.
• Detail-oriented with a high level of accuracy.
• Ability to research and solve problems with moderate supervision.

EDUCATION AND EXPERIENCE

• Bachelors degree in business administration healthcare management or a related field or equivalent work experience.
• 3 years of experience in claims processing specifically in life accident and health insurance or a related field.
• 5 years of progressive operations leadership and management experience within the life health and accident insurance industry preferably in Claims.
• Expertise in developing and executing on strategic plans.
• In-depth knowledge of insurance policies and medical records.
• Strong leadership and team management skills.
• Excellent analytical problem-solving and decision-making abilities.
• Exceptional communication and interpersonal skills.
• Proficiency in using claims management software and Microsoft Office Suite.

• Ability to work collaboratively across departments and with external partners.

The pay range for the role is $84700 to $144100. The specific offer will depend on an applicants skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.