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Allied American USA · 12 hours ago

Liability Investigations Claims Manager

United States

Full-time

Remote

Senior Level, Lead/Staff

10+ years exp

Allied American USA is seeking a highly capable Liability Investigations Claims Manager to join our TPA team. This fully remote manager directs a team of technical claims professionals and contributes to providing superb claims results for our clients.

FinanceInformation TechnologyInsuranceSoftware

Responsibilities

Handles oversight and QA on all non-litigated/complex claim files

Supervises the operation of multiple teams of examiners and claims staff for clients. Expert knowledge of full claim assignments in a TPA environment for General Liability (GL) and Property Damage (PD) programs including GLPD, GLBI, contractual liability, D&O, and full claim management up to litigation

Monitors workloads, provides training, and monitors individual claim activities for assigned team members

Provides technical/jurisdictional direction to examiners on claims

Supervises the examiner activities, coordinates priorities, monitors program timelines ensuring both Allied American USA and client requirements are being met while making sure to push early investigation of files

Supports claim examiners with any requests for assistance, escalated cases as defined

Completes reviews and analyzes management reports and takes appropriate action

Completes 15-, 60-, 270- and 450-day reviews on examiner files within 2 business days that is emailed daily

If direction is provided, it is expected that you will check in on file to confirm direction provided has been handled and if not handle additional follow up accordingly, involved VP when appropriate

Performs quarterly QA on 10 files per team member to ensure files are in compliance with service contract requirements and quality standards

Reviews all coverage letters; reviews high value reserve requests per client requirements for assigned team members

Reviews approval queue in CIMS at least twice daily to ensure that reserve and payment requests are being handled timely

Trains new team members; provides support, guidance, leadership and motivation to promote maximum performance; reviews all customer correspondence while examiner is in training

Manage Medicare reporting

Ensure examiners are complying with standards and expectations along with client specific protocols

Provides input on practice and procedures to improve operations

Prepares and conducts periodic joint training for entire program team in conjunction with executive management to train on the AM assigned client requirements and timeline mandates, to coordinate all operations and develop strong communication

Manage LT Monitoring

Coordinate and Collaborate with Litigation/Complex Claims Manager as needed

Qualification

Claims managementComplex claims handlingTeam managementTechnical directionQuality assuranceCommunication skillsLeadership skills

Required

10+ years of experience handling high-exposure, complex claims involving serious injuries and legal inquiries or disputes

Experience developing strategies to bring both litigated and non-litigated claims to satisfactory resolution

High level of experience including managing teams of 5 or more desk examiners

Experience with fatalities, D & O, complex commercial claims and managing litigated files

Expert knowledge of full claim assignments in a TPA environment for General Liability (GL) and Property Damage (PD) programs including GLPD, GLBI, contractual liability, D&O, and full claim management up to litigation