Director, Claims Appeals (Finance)
JOB DESCRIPTION
Combined Insurance, a Chubb Company, is seeking a Director, Claims Appeals for operations to join our fast-paced, high energy, growing company. We are proud of our tradition of success in the insurance industry of over 100 years. Come join our team of hard-working, talented professionals!
JOB SUMMARY
The Director, Claims Appeals is responsible for leading and managing the claims appeals department, ensuring efficient and effective processing of appeals related to claims, and confirming compliance with regulatory standards, including the Employee Retirement Income Security Act (ERISA) of 1974. This role involves strategic planning, team leadership, and collaboration with other departments, such as Claims, Legal, and Compliance to optimize the appeals process and improve outcomes. The director will guide the development and effectiveness of the team by advocating a climate of collaboration, ownership, and accountability, and work to maintain a level of excellence in the overall performance of the team.
RESPONSIBILITIES
- Serve as chief liaison for Claims Appeals activities.
- Develop and implement strategic plans to improve the efficiency and effectiveness of the claims appeals process.
- Lead, mentor, and manage a team of claims appeals specialists, providing guidance and support to achieve departmental goals.
- Oversee the review and analysis of claims, ensuring accurate and timely processing of appeals.
- Review and approve claims appeals decisions.
- Establish and maintain relationships with Claims, Legal, healthcare providers, and other stakeholders to facilitate the resolution of claims disputes.
- Monitor industry trends and regulatory changes to ensure compliance and adapt strategies accordingly.
- Analyze data and metrics to identify areas for improvement and implement process enhancements.
- Create and maintain accurate and comprehensive tracking around appeals volume and handling status.
- Engage team via coaching and mentoring to maintain culture of continuous improvement.
- Address complex claim issues and develop cross-functional solutions, partnering with stakeholders when needed.
- Build a knowledgeable, empowered, and self-driven team to inspire confidence inside and outside the department.
- Sets team goals and objectives, monitors performance, and develops and maintains a team focused on excellence.
- Ensure efficient allocation of resources and adherence to budget.
- Foster a culture of continuous improvement and professional development within the team.
- Provide input and make decisions on policies, systems, methods, and procedures for the effective management and control of the Claims Appeals functions.
- Maintain current knowledge of client needs, products, and insurance industry.
- Ensure incorporation of Compliance's interpretation of regulations and laws into Claims processes in a user-friendly way.
- Perform other duties as assigned.
COMPETENCIES
- Problem Solving:Takes an organized and logical approach to thinking through problems and complex issues.Simplifies complexity by breaking down issues into manageable parts.Looks beyond the obvious to get at root causes.Develops insight into problems, issues and situation.
- Continuous Learning:Demonstrates a desire and capacity to expand expertise, develop new skills and grow professionally.Seeks and takes ownership of opportunities to learn, acquire new knowledge and deepen technical expertise.Takes advantage of formal and informal developmental opportunities.Takes on challenging work assignments that lead to professional growth
- Initiative:Willingly does more than is required or expected in the job.Meets objectives on time with minimal supervision.Eager and willing to go the extra mile in terms of time and effort. Is self-motivated and seizes opportunities to make a difference.
- Adaptability:Ability to re-direct personal efforts in response to changing circumstances.Is receptive to new ideas and new ways of doing things.Effectively prioritizes according to competing demands and shifting objectives.Can navigate through uncertainty and knows when to change course
- Results Orientation:Effectively executes on plans, drives for results and takes accountability for outcomes.Perseveres and does not give up easily in challenging situations. Recognizes and capitalizes on opportunities.Takes full accountability for achieving (or failing to achieve) desired results
- Values Orientation:Upholds and models Chubb values and always does the right thing for the company, colleagues and customers.Is direct truthful and trusted by others.Acts as a team player.Acts ethically and maintains a high level of professional integrity.Fosters high collaboration within own team and across the company; constantly acts and thinks "OneChubb"
SKILLS
- Significant experience working with claims and claimants.
- Excellent verbal and written interpersonal and communication skills.
- Strong understanding of insurance policies and medical records.
- Excellent analytical and problem-solving skills.
- Ability to work independently and manage multiple tasks effectively.
- Detail-oriented with a high level of accuracy.
- Ability to research and solve problems with moderate supervision.
EDUCATION AND EXPERIENCE
- Bachelor's degree in business administration, healthcare management, or a related field or equivalent work experience.
- 3 years of experience in claims processing, specifically in life, accident and health insurance, or a related field.
- 5+ years of progressive operations leadership and management experience within the life, health, and accident insurance industry, preferably in Claims.
- Expertise in developing and executing on strategic plans.
- In-depth knowledge of insurance policies and medical records.
- Strong leadership and team management skills.
- Excellent analytical, problem-solving, and decision-making abilities.
- Exceptional communication and interpersonal skills.
- Proficiency in using claims management software and Microsoft Office Suite.
- Ability to work collaboratively across departments and with external partners.
ABOUT US
OUR BENEFITS
As a Chubb corporate employee, you have access to one of the most comprehensive benefit plans in the business, designed to meet your needs and help you reach your financial goals. More details can be found here. Chubb is committed to supporting its employees with a comprehensive compensation package that is appropriate in the market where they work. Below are several of the many benefits we offer our employees:
- Health insurance
- Dental insurance
- Tuition reimbursement
- A company-match 401(k) plan
- Disability insurance
- Life insurance
- Employee referral bonuses
ABOUT COMBINED INSURANCE
Combined Insurance Company of America is a Chubb company and a leading provider of supplemental accident, health, disability, and life insurance products in North America. Headquartered in Chicago, with satellite office in Columbia, SC, Combined is celebrating over 100 years in business. We are committed to making the world of supplemental insurance easy to access and understand. The company has an A+ rating by the Better Business Bureau and an A + (Superior) financial strength rating by A.M. Best. We are ranked by VIQTORY as the number one Military Friendly® Employer in 2023 (over $1 billion revenue category), marking Combined's twelfth consecutive year on the Top 10 list. We pride ourselves on approaching all situations with a Positive Mental Attitude (PMA) and encouraging collaboration.
ABOUT CHUBB
Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.
Connect with us on Twitter, Facebook, LinkedIn, and Instagram
#combined
