Claims Manager Jobs

Job Title: Team Leader, FML Claims Company: Prudential Location: Portland, ME Description: Responsible for managing an FML/STD Claim Team, to include staffing, training and supervising the activities of the disability/absence unit. Responsible for determination and payment authorization of disability claims. Supervises employees and provides guidance to subordinates regarding general claim policy, contracts and terminology. Reviews and settles problematic cases, but otherwise extends settlement authority to subordinates. Communicates with clients, state insurance departments and other internal and external areas. Has both technical and administrative responsibilities. Prudential and its affiliates, Newark, New Jersey are Equal Opportunity/Affirmative Action Employers and are committed to diversity in our workforce. Prior experience with disability claims. Prior experience with FML preferred. Strong communication and time management skills required. Proficiency in PC-based programs such as Word and Excel, as well as DCMS. Strong mathematical, problem solving, decision making & analytical skills are desired. Detail oriented. Interpersonal skills. Customer Service skills. Supervisory experience a plus, but not required. Demonstrated leadership skills a must. Understanding of STD/LTD product lines with experience of at least 2 years in claims preferred.

Job Title: Senior Disability Claims Examiner Company: Prudential Financial Location: Portland, ME Description: Prudential Financial, Inc. is a multinational financial services leader with operations in the United States, Asia, Europe, and Latin America. Leveraging its heritage of life insurance and asset management expertise, Prudential is focused on helping individual and institutional customers grow and protect their wealth. The company's well-known Rock symbol is an icon of strength, stability, expertise and innovation that has stood the test of time. Prudential's businesses offer a variety of products and services, including life insurance, annuities, retirement-related services, mutual funds, asset management, and real estate services. For more information, please visit www.prudential.com. The goal of the Senior Disability Claim Examiner is to efficiently and effectively direct disability claims toward the appropriate outcome while providing superior customer service and early intervention in the disability cycle to prevent short term impairments from becoming long term disabilities. The Senior Disability Claim Examiner is a multi-dimensional position whose responsibilities include, but are not limited to: Heavy written and verbal communication with a diverse population of customers, including claimants with physical and mental impairments, physicians, attorneys, benefit representatives, other healthcare providers, and internal/external clients. Facilitate the technical aspects of the claim and appropriately apply the legal and contractual provisions. Calculate appropriate dates and payments amounts accurately. Develop and maintain effective working relationships with group clients. Lead/participate in projects/activities such as Marketing presentations, Client meetings, Customer Action Teams, Claimant Visits, in-service training sessions and other projects related to claim management and staff development. Understand and correctly utilize the appropriate systems. Ability to manage multiple and changing priorities. Excellent organizational and time management skills. Strong written and communication skills demonstrated in previous work experience. Specific experience with collaborative negotiations. Proven skills in positive and effective interaction with challenging customers. Experience in effectively meeting/exceeding individual professional expectations and team goals. Demonstrated analytical and math skills. Ability to exercise sound judgment. High level of flexibility to adapt to the needs of the organization. PC skills preferred (i.e., Windows based environment) College degree preferred. On September 30, 2009, Prudential will upgrade the technology we use to receive job applications. Any job applications, resumes, and/or cover letters that are submitted to Prudential prior to September 30th, will not be converted to the new system. If you apply now and are still under consideration for the job opportunity, you will be asked to spend a few minutes reapplying in the new system. After October 1st, we invite you to take a moment to create a profile and request future Job Posting Notifications in the new system. Activating the Job Posting Notifications tool will allow you to be notified confidentially via an email, of any positions that match your specified career preferences. Going forward, you can check the status of your application by logging in at any time. Thank you. The Prudential Insurance Company of America and its affiliates, Newark, New Jersey are Equal Opportunity/Affirmative Action Employers and are committed to diversity in our workforce. Prudential is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity unless contracted with Staffing. Agencies must work with Staffing as the primary point of contact and follow the Prudential application process to be considered for business. Regardless of past practice, all resumes submitted by search firms to any employee at Prudential via-email, the Internet or directly to hiring managers at Prudential in any form without a valid written search agreement in place for that position will be deemed the sole property of Prudential, and no fee will be paid in the event the candidate is hired by Prudential as a result of the referral or through other means. Note: Any search agreement entered into with Prudential before January 2004 is null and void. Search firms are essential to the recruitment and staffing efforts at Prudential and we value the partnerships we have built with our preferred vendors. For this reason, Prudential has established and regularly maintains a preferred vendor list. Please note that even preferred vendors need to have a written search agreement signed by the Director, Recruiting Programs, Staffing at Prudential in place for the specific position in order for a fee to be paid for any candidate referrals.

Job Title: Director, FML Company: Prudential Location: Portland, ME Description: This position has ultimate accountability for claim administration and claims management for FMLA and Short Term Disability product. This involves setting expectations for each team and the division, and ensuring that those expectations are met by working closely with associates throughout the division on making appropriate claim and absence determinations and directing claimants back to work.   Prudential and its affiliates, Newark, New Jersey are Equal Opportunity/Affirmative Action Employers and are committed to diversity in our workforce. Experience managing FMLA and STD claims staff People management experience 5+ years with experience in associate development Experience introducing and managing within a newly developed process Experience in Process redesign efforts Change management experience, ie, leading change experience Effective written and oral communication to both internal and external customers. Some travel required, up to 25%. 5+ years experience with change management, and organizational development

Job Title: Claim Supervisor - Claim Company: OneBeacon Insurance Group Location: Canton, MA Description: OneBeacon blends a 175+ year history and financial strength with anopportunistic and dynamic culture. Our “think like owners” mindset is reinforced through truepay for performance featuring an ESOP, incentive plans and competitive base payand benefits.  Our entrepreneurialspirit showcases our employees’ deep expertise and nimble approach.  This hallmark OneBeacon style uniquelypositions us within the property-casualty insurance industry.   OneBeacon Insurance Group’s underwriting companies offer a rangeof specialty and segmented commercial and personal insurance products soldthrough select independent agents, regional and national brokers, andwholesalers.  As one of the oldestproperty and casualty insurers in the UnitedStates , OneBeacon traces its roots to 1831 andthe Potomac Fire Insurance Company. Today, OneBeacon’s U.S.headquarters is in Canton, Massachusetts .  The company is publicly traded on theNew York Stock Exchange under the symbol “OB”.    We currently have an opening for a Property Claim Supervisor to joinour Corporate Headquarters. This position can be located in any of thefollowing OneBeacon offices: Canton, MA, Buffalo, NY, Denver, CO, orMinnetonka , MN. Our Claim Supervisors are responsible fordeveloping plans, analyzing results, overseeing daily work of direct reports andproviding direction or recommendations on complex and/or high exposure claims.  Responsibilities: 1) Supervises 4-7 professional and technical staff members. Manages unitstaffing issues; including ensuring appropriateness of staffing levels,creating, implementing and monitoring of performance plans for direct reports. 2) Monitors reserving activity to ensure compliance with corporatepolicy.  3) Reviews and documents recommendations for claim disposition;including evaluation, negotiation and settlement of claims in excess of staffauthority levels.  4) Reviews and analyzes claim reports to identify and address trends.Recommends strategies to correct adverse trends.  5) Monitors vendors and independent adjusters to ensure servicequality.   6) Ensures execution of claim handling strategies; includingappropriate determination of coverage, liability and damages. 7) Anticipates and meets all customer needs (internal and external).  Requirements: The ideal candidate will have strong Property and Inland Marine claimstechnical knowledge (Commercial Lines), and legal exposure in local market isessential. Excellent negotiation, verbal and written communication skills arenecessary. Must have the ability to develop and maintain strong relationshipswith agents and business partners. Must interact with internal and externalpartners and customers. Demonstrated proficiency with computer softwareincluding current Windows Operating System, Microsoft Office, and MicrosoftOutlook. Must maintain a high level of accuracy, and provide follow-through onprojects. Requires the ability to maintain confidential information and workindependently and as a member of a team.   Education and Experience:High school diploma with demonstrated insurance or technical experiencerequired,  Bachelors degree preferred. 7-10 years of commercial linesproperty claims experience including Commercial Property and Inland Marine,with 1-3 years of supervisory experience.

Job Title: Regional Claims Manager (Wells F Company: Wells Fargo Location: Chicago, IL Description: Job_Posting_Title: Regional Claims Manager (Wells Fargo title: RCIS Regional Field Manager)Requisition_Number: 3309933Executive Org_Description: WHOLESALE BANKINGSchedule Type: RegularShift: 1Scheduled Hours: 40State: ILCity: FIELD REPJob_Contact_Company: Wells FargoJob Description: Rural Community Insurance Services, (RCIS), a Wells Fargo company and a leader in the crop insurance industry, has a full-time Regional Field Manager position available to cover the territory of eastern Wisconsin, Illinois, Indiana and Michigan. Incumbent will office out of their home in the territory.RCIS offers a comprehensive benefits package. Salary: DOE.Job Description:Develop and implement an effective regional claims organization for the territory; manage staff - including hiring, performance management, salary administration, coaching and development; provide coaching to staff to ensure all field adjuster activities are performed in compliance with federal, state and RCIS standards; provide guidance and management assistance to staff on complex claims; develop and implement effective Loss Adjustment Expense oversight for the region; develop communication plans to ensure important issues are effectively communicated throughout the region; will monitor annual budget for the region; develop and implement effective recruiting plans to meet regional needs; collaborate with National Claims Training to identify training needs and deliver effective classroom and field training targeted at regional issues; establish effective working relationships with the Regional Underwriting office(s)Minimum Qualifications: 7+ years crop insurance experience; 3+ years supervisory/management experience; excellent verbal and written communication skills; strong computer skills; strong presentation skills; significant travel required.How to Express Interest in This Job: Wells Fargo invites you to apply for this job at https://employment.wellsfargo.com/psp/PSEA/APPLICANT_NW/HRMS/c/HRS_HRAM.HRS_CE.GBL?Page=HRS_CE_HM_PRE&Action=A&SiteID=1&Opening=3309933.WELLS FARGO IS AN AFFIRMATIVE ACTION AND EQUAL OPPORTUNITY EMPLOYER M/F/D/V.3309933

Job Title: Homeowners and Flood Insurance Claims Manager - Company: Location: New Orleans, LA Description: We are looking for a Homeowners and Flood Insurance Claims Manager. This position has clear and distinct accountability for business results. You will oversee daily operations in multiple states. The manager oversees close to 500 Homeowners and Flood Insurances Claims Adjusters Nationwide. The manager will review the management and investigation of various Homeowners and Flood Insurances claims. They will also verify claims, secure information and review coverage with claims adjusters and team managers (claim supervisors). This job is based out of New Orleans. Job Requirements Skills, Knowledge & Abilities * Strong background in claims and sales * Must possess high level of energy * Must be a Self-Starter * Ability to effectively lead, coach and develop the claims staff. * Technical expertise, claims resolution skills and knowledge of insurance and claims principles, practices and procedures. * Strong communication, negotiation and presentation skills. Ability to effectively interact with all levels of the company's internal and external business partners. * Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects. * Ability to deal with ambiguous situations and issues. * Creativity in resolving unique and challenging business problems. * Ability to achieve business goals and objectives. * Knowledge of Microsoft Office Suite and other business-related software. Job Requirements * Experience as a manager or supervisor * Previous claims handling experience * Previous sales/marketing experience Send resume if interested. Free Craigslist Hit Counters!

Job Title: Insurance Claims Manager Company: Kforce Finance & Accounting Staffing Location: Oak Brook, IL Description: .mainbody .RightColumn .LeftColumn a .jlocation .jdetail .jtitle .jdescription .jFontstyle14 .jFontstats .jFontstyle13 .jFontstyle16 .jFontstyle17 .position .jFontstats Status: Full-Time, Employee Level: 2-5 Years Experience Job Location: Oak Brook, IL Job Ref Code: FAEQG952746 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . About Kforce Finance & Accounting . . . . . . . . . . . . . . . . With over 45 years of experience, Kforce continues to set the standard in the finance & accounting staffing & solutions industry. With an unwavering commitment, Kforce strives to provide candidates with exceptional service in meeting their employment and career needs. Kforce provides consulting, contract-to-hire or direct hire positions with a wide range of organizations; from small, privately held companies to large, multinationals. Our finance & accounting specialty areas include: accounting, finance, compliance, audit, credit/collections/financial administration, title/escrow, mortgage, banking/credit union, administrative and insurance. Backed by approximately 1,900 staffing specialists, Kforce is committed to "Great People = Great Results" for our valued clients and candidates. Our Firm operates with 62 offices in 41 markets in North America and two in the Philippines. Kforce is an EEO/AA Employer . POSITION Insurance Claims Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Job Description: Our client is seeking an Insurance Claims Manager.The responsibilities of this position include the following: Analyze and approve referral claims over the administrator's authority level. This includes reviewing for compliance with the claims settlement practices to ensure claims are acknowledged, delay letters sent and appropriate follow-up has been done as well as mandated benefits applied correctlyDocument claims practices and procedures and communicate them to administratorsPerform TPA claim operational audits to ensure compliance with procedures and applicable state guidelinesExpected travel required to conduct on-site auditsPolicy interpretation to ensure TPA's are adjudicating claims in accordance with policy provisionsExcellent verbal and written communication skills regarding claim approvals and decisionsMonitor backlog for timely review of claim referralsIdentify potential concerns and make recommendations to effectively resolve the situationAttend staff, client and department meetings to address concerns or accomplishmentsDepartment goal setting to ensure meeting expectations of claims handling, projects and business travelProvide back-up support to staff for complaint handling, phone calls and legal issues that may be presentedClient meetings held on-site or off-site to discuss overall claim operationsComplaint handling with administrators; review and approve responsesResponsible for appeals and determining when the Appeal Committee should meet for review of the second level appealsCoordinate state surveys with administrators. Collect data and analyze for complianceMonitor compliance and mandates from the states to determine applicability for lines of business and communicate to the appropriate TPA(s)Continue to review and ensure compliance under the HIPAA regulations internally and externallyCommunicate carrier claims practices and procedures to TPA'sCommunicate verbally or in written formatThe skills, experience, and education required for this position include the following: General knowledge of claim practices for STD, LTD, Life, Waiver of Premium, Fully Insured, AD/D, Medical claims adjudication/auditingKnowledge of medical claim terminologyMinimum of 5 years of claim experienceExperience in various claim adjudicationKnowledge of various software packages and computer applicationsAbility to travel up to 15-20% of the timeAbility to work independentlyProficient in the use of Excel, Word, Outlook, and Internet ExplorerInsurance industry experience is preferredStrong communication skills, both oral and writtenExcellent organizational skillsAbility to work independentlyApply for this job Great People = Great Results

Job Title: Project Manager (Insurance claims) Company: Korcomptenz Inc Location: Warren, NJ Description: We are looking for Project Manager (Insurance claims) position in Warren, NJ * Long Term Contract.Requirement details:The primary responsibility of the PM will be as follows:* Project Manager to work on the iVOS Claims Administration system. * Act as liaison between various project vendors for implementation of AON iVOS system* Experience in Covered Claims and Insured Claims* Experience in data migration projects (from multiple systems)* Ability to manage project management, task management, manage project plan, resource plansIf you are interested in the above opening please respond with your word resume and provide us the following details. * * Full Name:* * Rate Expectation:* * Citizenship / Visa Status : * * Availability for Interview : * * Contact Number (s) : * * Email id :* Start Date : * * Current City and State: Warm Regards, NirmalKorcomptenz IncDirect : Register to View Fax : Register to View Web : www.korcomptenz.com_______________________________An ISO 9001:2000 Company

Job Title: Major Claims Manager - Property Company: Ace USA Location: Roswell, GA Description: ACE GroupThe ACE Group of Companies is one of the worlds leading global commercial property and casualty insurance and reinsurance organizations, with 16,000 employees worldwide and offices in more than 50 countries.ACE serves the property and casualty insurance needs of businesses of all sizes in a broad range of industries. We also provide specialized insurance products—such as personal accident, supplemental health and life insurance—to individuals in select countries. Our reinsurance operations include both property and casualty and life companies.Details of this critical opening follow:BASIC FUNCTION:Handle complex property claims requiring a high degree of technical expertise, including experience handling litigated matters, complex coverage issues, and multi party negotiations. Incumbents must exhibit leadership in the technical area to provide technical support to the team, and must require minimal direct technical supervision by the Manager. Excellent verbal and written communication skills required.ESSENTIAL FUNCTIONS: Must be able to interpret policy verbiage and evaluate coverage as it relates to a given claim. Must have the ability to establish action plans and course of investigation for proper documentation; and, proactively supervise/direct independent vendors and legal counsel, leading to final resolution of a given claim. Must be able to utilize PC systems for entry of claims information in a paperless environment. Must be able to use PC tools such as Microsoft Word, EXCEL, etc. for communication, documentation and organizational purposes.Must be able to communicate well, both verbally and written, with customers as well as in-house personnel, and claim file parties; and, present self with high integrity and professionalism. ACCOUNTABILITY: Accountable to manager or Team Leader for any task assignments that may be assigned in conjunction with Property Claims Team activities and operation. May have some supervisory responsibilities. Accountable for proper claims handling procedures and processes in keeping with Best Practices. Accountable to the Company for servicing customers and the general public, as may be related to specific Company directive and philosophy, for the well being and protection of the Company assets, image, and industry standing.QUALIFICATIONS: College Degree or Equivalent. Graduate and/or Law Degree a plus. CPCU and other Industry designations a plus. Minimum 10 years experience combined with a high competency level for policy coverage analysis, in conjunction with supervising the investigation and adjustment of complex Commercial Property and Inland Marine claims. Prior experience handling large building, business personal property, and Time Loss Element claims a plus.ACE offers a competitive salary plus cash bonus, equity opportunities and a comprehensive benefits package including life, health, dental, vision, a generous retirement savings plan with a generous company match, disability coverage, stock purchase plan, flexible spending accounts, tuition reimbursement, and business casual dress.Sound like the right job for you? For consideration, please apply below. If you would like additional information about the ACE Group, please visit our website at http://www.acelimited.com

Job Title: Claims Supervisor - Company: Location: Monterey, CA Description: Company Information The Alliance is a regional non-profit Medi-Cal health plan serving over 180,000 beneficiaries in Santa Cruz, Monterey and Merced Counties. Since 1996, the Alliance has worked to improve health care for people living in the Central Coast region. In 2009, our service area expanded to include residents of California?s Central Valley in Merced County. The Alliance values its culture of diversity, and operates with a management team that cares about and values its employees. Our philosophy of building long term quality relationships with our customers applies both externally and internally. We work continuously on creating an environment that makes us an employer of choice. Our programs include Medi-Cal Managed Care in Santa Cruz, Monterey and Merced Counties, and Healthy Families in Monterey and Santa Cruz Counties. Additionally, the Alliance administers the Healthy Kids Program in Santa Cruz County and the Alliance Care In Home Supportive Services (IHSS) Program and Access for Infants & Mothers (AIM) Program in Monterey County. With the support of our many partners, the Alliance is shaping a healthier future by creating local healthcare solutions. Duties and Responsibilites: 1.Responsible for daily claims processing operations, provider calls and inquires via phone, fax and/or mail, day-to-day supervision of the claims staff and management of the claims inventory and functions, with duties including but not limited to: ?Day-to-day direct supervision and management of the Claims Department staff; ?Monitor, support and assure efficient and accurate performance of the claims processing operation, including the process by which claims are received, scanned and batched for processing (Claims Control), claims entry (Verifying and Processing), proper administration of benefit and payment rules (Adjudication), appropriate provider communication via phone and written correspondence and accurate configuration of the claims processing system (Systems); ?Supervises and plans department functions to meet short and long term department goals and objectives including the promotion of teamwork and cooperative efforts among employees; ?Issues work assignments to Claims staff including cross-training planning with Claims Trainer; ?Prepares and reviews quality control audits with staff to ensure compliance within established department guidelines, goals, policies and procedures. Performs concurrent claims audits on supervised staff. Identifies errors and deficiencies; develops and implements corrective action and training plans for staff; ?Provides employee development opportunities thru project assignments, instruction and feedback; ?Performs analysis and development of modifications to the operation; ?Produces policy and procedure instructions for the Claims staff which includes development, implementation, and interpretation of policy and procedures for the Claims Department; ?Produces and maintains statistics of claims production and inventory for Claims Operations Manager on a daily, weekly, and monthly basis; ?Assist Trainer with training curriculum for supervised staff; ?Interviews and participates in the selection of qualified candidates. Evaluates performance of and provides developmental opportunities for staff. Counsels staff when there are performance problems or issues. ?Assists staff with time management including, monitors time and attendance, approval of time off requests, reviews and signs time cards and ensures proper staffing during staff vacations and absences. ?Assists in the review and analysis of claims inquiries, claims tracers, pended claims, explanation of benefits, batch reports and other reports to resolve specific claims or provider issues; ?Supervision of the claim?s paper flow within the Claims Department. To include, but not limited to: claims mail, document scanning and storage, claims inventory, claims processing, pended claims and claims inquiry resolution; ?Interacts with all other departments as needed to resolve claims related issues and assist in policy planning and implementation; ?Responsible for the Claims Quality Control (QC) process. To include, but not be limited to: Implementing the quality control process; revising the process as needed, monitoring, tracking, auditing and reporting QC outcomes; identifying QC issues; and developing and implementing corrective action plans as needed; ?Maintains current knowledge of Alliance policy and procedure, EDS Provider Manuals, OILs and Title XXII regulations; ?Maintains current versions of the Claims Manual, TAB 5, Knox Keene and other Claims Department related documents such as job descriptions and the Claims Section of the Alliance Provider Binder ?Maintains excellent working knowledge of the use of and ability to modify various software tools used in the Claims Department including AIS?s CodeManager, GNAV, MacroSoftware, and Discoverer; ?Assists in the development, installation, testing and management of new software/hardware/networking solutions which currently includes DataCap (claims OCR) and DiskImage (on-line claims archive), Claims Queue; ?Responds to elevated/urgent provider issues when necessary; ?Modifies/adjusts claims when necessary; ?Provides and/or participates in provider meetings both on and off site as required; ?Provide coverage for the other Claims Supervisor in their absence; and ?Leads or participates in special projects and assignments as needed. ?Other duties as required and assigned. Education and Experience: ?Minimum AA or equivalent experience. ?Bachelor?s Degree in related coursework preferred. ?Minimum three years claims management experience including staff supervision or equivalent. ?Experience and skill in operating computer terminals and calculators. ?Experience and knowledge of medical terminology and billing/coding systems. ?Previous managed care experience preferred. Knowledge and Abilities: ?Ability to coordinate, delegate and supervise the work of others ?Thorough knowledge of Medi-Cal claim processing functions; ?Typing ability of 30-40 wpm and 10-key by touch required; ?Ability to think and work effectively under pressure; ?Ability to multi-task and prioritize multiple deadlines; ?Ability to maintain accurate records; ?Knowledge of medical terminology, related procedures and diagnostic coding, and knowledge of how to access available resource tools. ?Excellent oral and in writing skills required ?Knowledge of or ability to operate MS Word, Excel and Outlook (e-mail and scheduler) required; ?Ability to work effectively with a wide variety of professional and non-professional staff; ?Demonstrated ability to train staff on function of claims operations; ?Ability to assume responsibility, display initiative and exercise good judgment in making decisions within the scope of the position; ?Demonstrated ability to exercise diplomacy and tact; ?Demonstrated ability to maintain confidential information; and ?Valid California Driver License, transportation and automobile liability insurance in limits acceptable to The Alliance. Benefits include: Anthem Blue HMO or PPO Delta Dental Premier Plan Vision Service Plan Domestic Partner Benefits Twenty-Eight Days PTO annually Eleven Paid Holidays 401(a) Retirement Plan - Employer contributes 10% CalPers 457 Deferred Compensation Retirement Plan Roth IRA Costco Membership (paid annually for employee and spouse/domestic partner) Medical Expense Reimbursement Plan & Dependent Care Plan Health & Wellness Program ? up to $460 gym membership reimbursed annually Tuition Reimbursement - $1,000 annually Annual Flu Shot PTO Sellback Plan PTO Donation Program Employee Assistance Program Recruitment Incentive Program Long Term Disability Life Insurance and AD&D plans Prepaid Legal Services Please visit www.ccah-alliance.org/careers.html to apply. The Alliance i