Amalgamated Life Insurance Supervisor, Claims/Trainer in White Plains, New York
The Supervisor/Trainer of claims is responsible for the direct supervision of the Claims Analysts as well as providing training to new hires and existing Claims personnel and other departments on refresher Claims Topics as necessary.
Oversees the administration of the assigned claims processing unit, including all functions and processes required to process medical, hospital, vision, dental and other claim types.
Performs personnel and job supervisory duties required to ensure that staff is meeting performance goals; conducts annual performance reviews; confirms production incentive; monitors employee attendance and lateness.
Monitors individual analyst production and quality providing feedback, support, and instruction to assist staff with meeting goals.
Manages claims inventory via Workflow with a goal of meeting required JAA and DOL turnaround time requirements.
Provides daily guidance and technical instruction to the claims staff, ensuring that claims are handled timely and appropriately.
Identifies training needs and conduct training for all Claims Personnel as necessary, including new hire classes.
Works with quality assurance department to provide feedback and corrective action on claims quality.
Must possess a working knowledge of all plans for which he/she is responsible and keeps up to date on any benefit plan and procedural changes that must be communicated to staff.
Oversees the claims correspondence ensuring handling within DOL timeframes; prepares responses if needed.
Interfaces with AMM on medical claim referrals and any pre-certification issues.
Consults with appropriate personnel through-out the company to obtain information required to resolve and process claims.
Maintains knowledge of eligibility requirements and understands the complexities of the system interfaces.
Monitors and oversees the correct handling of high dollar claims ensuring timeliness of handling; reviews, examines, and directs processing of unusual or difficult claims
Oversees the review, distribution, and response to Customer Service and service/account rep referrals/ inquires.
Handles various assignments or projects, as needed.
Analyze benefit documentation for new plans and existing plan benefits changes to ensure all documentation is accurate and current.
Engage in learning any new systems, functions or new claims technology, document and conduct training classes.
Assist with new hire implementation as necessary.
Assist in maintaining the Claims training manual and must stay abreast of all Federal and state laws affecting Claims payment.
Escalates any and all claims issues that is adverse the overall departmental claims department quality.
Bachelors or Associates degree preferred.
Supervisory or related experience preferred.
Five or more years work experience in handling health insurance or self-funded claims.
NYS A&H Adjuster license (to be obtained within 3 months of employment)
Familiarity with industry terminology and claim related medical terminology.
High level of organizational and problem solving skills.
Excellent written and verbal communication skills.
Team player and willing to collaborate with management team.
Good computer skills, including use of MS Word and Excel.
External Company Name: Amalgamated Life
External Company URL: http://www.amalgamatedlife.com
Street: 333 Westchester Avenue