lavori da Health Insurance Specialist in località United States

The Insurance Claims Manager is responsible for overseeing the claims processing operations, ensuring efficiency, accuracy, and compliance with industry regulations. This role requires strong leadership, analytical skills, and expertise in risk assessment. The manager will work closely with claims adjusters, policyholders, legal teams, and other stakeholders to ensure timely and fair claim settlements. The ideal candidate should have experience in managing claims for various insurance types, including health, auto, property, and liability.

• Oversee the claims processing workflow to ensure timely and efficient handling of claims.
• Evaluate complex claims and make decisions on settlements based on policy terms and conditions.
• Develop and implement claims management policies and procedures to improve operational efficiency.
• Monitor claims trends and identify potential risks to mitigate financial losses.
• Ensure compliance with industry regulations, company policies, and legal requirements.
• Train and mentor claims adjusters and support staff to enhance team performance.
• Collaborate with underwriters, legal teams, and investigators to resolve disputed claims.
• Conduct regular audits and reviews to maintain the quality and integrity of claims processing.
• Manage relationships with external vendors, such as medical providers, repair services, and legal firms.
• Prepare detailed claims reports and presentations for senior management.

• Bachelor's degree in Business Administration, Finance, or a related field.
• 5+ years of experience in claims management, preferably in health, auto, or property insurance.
• Strong knowledge of insurance policies, claims procedures, and regulatory compliance.
• Experience in handling complex and high-value claims.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong leadership and team management abilities.
• Proficiency in claims management software and Microsoft Office Suite.
• Ability to handle negotiations and resolve disputes effectively.
• Strong communication and interpersonal skills.