Claims Manager Responsibilities and Duties

Design and implement various policies and procedures for claims.

Provide services to all business requirements and ensure optimal handling of all claims and investigate all issues and provide training for all business units.

Evaluate all new claims and administer all data integrity data and manage communication to safety department and monitor all claims exceeding $5000 and ensure timely closure.

Evaluate all business units associate claims.

Provide training to juniors to manage all outstanding claims and design an efficient duty program and coordinate with HR team to facilitate same.

Perform regular quarterly audits on all local TPA offices.

Monitor effectiveness of all programs and provide support to all open claim file reviews and manage all payment cycle to ensure compliance to all contract requirements.

Design and maintain panel of investigators to use all TPA and prepare reports for monthly chargeback for all business units.

Analyze all claims to ensure optimal quality and prepare reports for various business units and monitor all chargeback expenses and provide report to all clients and management.

Perform investigation on all reserve increases and perform regular surveillance of all claim issues and maintain efficient location code listing for TPAs.

Provide all claim kits and auto ID card to various business units and recommend improvements in processes to increase proficiency and supervise effective resolution of all claim inquiries.

Schedule all internal and external audits on all claims issues and supervise processing of all billing issues.

Oversee all electronic claims processes and evaluate all self insurance applications and prepare claims reports and evaluate all actuarial.

Analyze all claims and identify all risks and ensure processing of all claims as per company policy.

Forecast all staffing requirements and identify and resolve all issues effectively and schedule all employee attendance.

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