Claims Technical Lead

• Act as a main point of contact for claims-specific questions from case managers
• Mentor new hires and support new-hire training
• Participate in refresher training and development of existing staff
• Ensure case managers use appropriate risk-management skills to secure appropriate claim outcomes
• Conduct manager reviews and audits of claims as necessary to ensure overall quality
• Provide coaching and feedback to case managers
• Monitor KPIs and reports to ensure service levels and commitments are met
• Monitor and adjust workload balancing for case managers
• Support management in facilitating team meetings and huddles
• Periodically manage complex cases and customer escalations
• Elevate trends and coaching opportunities to the leadership team
• Complete special projects and ad hoc assignments requested by leadership
• Perform other related duties as required

Requirements

• Ability to influence and champion change
• Excellent critical thinking and decision-making skills
• Strong leadership and organizational skills
• Excellent verbal, written, and presentation communication skills
• Strong understanding of contracts, plans, and products
• Strong knowledge of best practices and effective case management skills
• Bachelor's Degree in Health Administration, Business, or a related field
• 4 or more years of job-related experience
• 2 years of case management experience in STD/LTD, Life, Absence Management, or a related field/industry
• Equivalent combination of education and experience accepted

Core Competencies

Demonstrates strong leadership and organizational skills while effectively managing case managers and ensuring quality outcomes. Possesses a solid understanding of case management practices and the ability to influence change within the team.

Highest-signal resume keywords

• Case Management Experience
• Leadership Skills
• Critical Thinking
• Communication Skills
• KPI Monitoring

Hard Skills

• Risk Management Skills
• Claims Auditing
• Contract Understanding
• Best Practices in Case Management
• Decision-Making

Soft Skills

• Mentoring
• Coaching
• Organizational Skills
• Influencing Change
• Presentation Skills

Certifications & Qualifications

• Bachelor's Degree in Health Administration
• Bachelor's Degree in Business

Industry Keywords

• STD/LTD
• Life Insurance
• Absence Management
• Claims Management
• Customer Escalation