A-G Specialty Insurance · 2 hours ago
Claim Service Manager
Berwyn, PA, US
Full-time
Hybrid
Mid, Senior Level
$60K/yr - $65K/yr
3+ years expA-G Specialty Insurance is seeking a Claim Service Manager to lead a team that processes Accident & Health insurance claims. The role involves managing and developing the team while ensuring compliance with legal regulations and maintaining constructive relationships with stakeholders.
Customer ServiceInsuranceSports
Responsibilities
Interview, hire, train, and develop Claim Service Team
Ensure legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations and enforce equally and fairly on team
Analyze workload index and delegate responsibilities as needed
Review monthly claim audits along with performance management that includes goal setting, feedback, disciplinary action, and rewards
Developing performance metrics, goals, and best practices for both individuals and team
Establish and maintain constructive relationships with customers, clients, providers, and other key stakeholders
Monitor and provide feedback to Claim Management Leadership on the company’s proprietary claims system performance and areas of opportunity for system enhancements
Create a workplace culture that is consistent with the company’s mission, vision, and values
Assist in resolving complex claim and services issues
Demonstrate fundamentally sound claim handling by achieving compliance in the areas of investigation, coverage and processing of claims
Timely and appropriately communicate with the claimant and client, as well as internally
Establish proof of loss by reviewing medical documentation; assembling additional information as required from outside sources; including claimant, client, provider, and other insurance companies
Calculates and pays benefits due; approves and makes timely claim payments and adjustments
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
Recognize and properly address coverage issues, potential fraud, and subrogation
Ensure claim files are properly documented through internal notes and correspondence logs, and claim coding is correct
Refer cases as needed to Vice President of Claims, Insurance Carrier, Program Management, and other appropriate parties internally and externally
Qualification
Required
Bachelor's Degree or comparable experience
Ability to perform each essential duty satisfactorily
Team Player
Excellent verbal and written communication
Behavior flexibility, ability to adapt management style
Advanced critical thinking and problem-solving skills
Strong decision-making ability and sound judgement
Knowledge and understanding of Department of Insurance regulations
Exhibits leadership qualities and forward-thinking mindset
Ability to obtain and maintain Insurance Adjuster License
Preferred
3-5 years insurance experience
Accident & Health Adjuster License
Company
A-G Specialty Insurance
A-G Specialty Insurance is a sports insurance firm.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
James Shipp
Chief Growth Officer
Joe G.
Director of Collegiate Partnerships
Recent News
2024-11-21
Company data provided by crunchbase