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Guardian Life · 2 weeks ago

Team Leader, LTD Claims Case Management

United States

Full-time

Remote

Mid, Senior Level

$59K/yr - $96K/yr

5+ years exp

Guardian Life is seeking a Team Leader for their LTD Claims Case Management team. The role involves overseeing the adjudication of LTD claims, managing staff performance, and ensuring compliance with best practices and regulations while fostering employee development and collaboration across departments.

DentalFinancial ServicesHardwareInsuranceLife Insurance

No H1B

Responsibilities

Validate that all LTD claims are accurately and fairly adjudicated according to plan provisions, established best practices and within state and federal guidelines

Manage and resolve issues that pertain to claim administration procedures cost containment activities, reports and quality control issues

Serve as primary resource for the team and provide direction to the staff members by setting objectives, communicating progress and goals, and holding the staff accountable for adhering to all quality assurance, turnaround times, best practice standards, and operational efficiency

Assist staff with career development and career progression

Develop employee goals to promote career growth that enhance level of knowledge for future opportunities

Cross collaboration with business partners including Life and Disability, CRU, SIU, Sales Force, Group Quality Management and other areas within the company

Promote leadership model to support Guardian values

Develop and communicate objectives and performance goals for the department

Managing direct report’s performance by coordinating with HR business partners to develop coaching plans and performance improvement plans

Create yearly action plan based on the results from the employee engagement survey

Based on feedback from technical consultant review daily, weekly and monthly reports on team productivity 1) for operational reporting and monitoring purposes; and 2) to identify trends and training opportunities

Coordinate and monitor overpayment recovery efforts, vendor/legal negotiations and tracking for liability and reporting purposes

Monitor claim turnaround times to validate decisions are made within DOL and policy time frames

Oversee settlement checks in accordance with settlement agreements

Assist in self-testing for MARs Financial Control

Develop training tools in conjunction with technical experts to deliver training to the staff

Empower staff through brainstorming sessions to revise workflows and procedures that promote best practices

Support strategic initiatives from a Life/DI claim perspective with contract rewrites and related projects

Prepare agenda, schedule and facilitate team meetings

Mentor, coach, supervise and develop talent of direct reports by recommending and coordinating training plans for individuals to exceed personal and departmental goals and objectives

Review claim staff QA assessments for training or enhancement opportunities

Identify Continuous Improvement opportunities by reviewing process and eliminating unnecessary steps

Validate refund and returned checks are processed in an accurate and timely manner and in accordance to departmental policy

Assist manager with departmental budget and vendor expenses

Identify claim success stories that promote Guardian’s value proposition

Qualification

LTD claims experienceAnalytical skillsLeadership experienceMicrosoft OfficeDCMS claim systemRegulationsOrganizational skillsTime managementOral communicationWritten communicationPresentation skills