Adjudication Lead, Sr (Finance)

JOB DESCRIPTION

Combined Insurance, a Chubb Company, is seeking a Sr. Adjudication Lead 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 Senior Adjudication Lead role will guide and support the efforts of a small (6 - 8 staff) Claims Adjudication team to meet production and quality goals working closely with their assigned Claims Adjudication Manager.This will include reviewing and approving medium and complex claims handled by their assigned adjudication team to authorize claims payments (over authority review), review denials, and generally assess the quality of work from their adjudication team.The role will also monitor and assist with Claim escalations from customers or other service areas to ensure any concerns or issues with claims assigned to their team are handled in a responsive, customer centric manner.

This position will also emphasize developing the craft of claims adjudication at each complexity level by working closely with each team member to assist with questions, issues, and the development of their adjudication skills.The Senior Adjudication Lead will work closely with the Claim Adjudication and Customer Experience Practices Leader to design and implement improved adjudication practices and enhanced customer interactions that will allow us to provide the service experience our customers expect.

To succeed, the Senior Adjudication Lead must have deep technical expertise in all aspects of our systems and knowledge of the claim adjudication processes and procedures for all of our A&H products.They are expected to develop a collaborative relationship with the Adjudication team they are helping to lead while also assisting them to overcome challenges and develop their skills and capabilities.Person in this role must have strong coaching skills that reach people at an individual level which ultimately impacts the performance of team at large.

While this role will work extensively in support of our internal claims staff, they will also need to monitor and understand the performance of our FNOL, SAT, CPT teams & peers as it may be impacting the performance of their adjudication team.They will work with their Manager and Director as needed to ensure effective end-to-end administration of claims handling with a focus on an exceptional customer experience. The Senior Adjudication Lead alsoseeks to enhance our claims handling capabilities to meet current and future strategic business needs with new products, distribution channels, policy administration/claim systems and strategic partnerships.

Responsibilities

• Assists their assigned Adjudication Manager with monitoring workload, productivity, and quality for the team.This includes helping to ensure work assignments are appropriate to skill level and Tasks are completed within target SLAs to meet time-service expectations
• Assists the team with complex A&H Claim Adjudication tasks and reviews claims payments that are over the authority level of the adjuster handling the claim or reviews and signs off on denied claims.Interacts internal & external resources as needed to influence positive outcomes for the case
• In collaboration with their manager, coaches and provides ongoing training and guidance (both technical and behavioral) to all complexity levels of Combined Adjudication staff assigned to them (5-7 staff).This includes developing the Adjudicationstaff in claim investigation, letter writing & customer interactions
• Facilitates daily and weekly team huddles with a focus on the skill of claim handling including discussion on claims adjudication best practices, resolution of problems and issues, and ensuring the best possible customer experience
• Through their normal course of job duties, monitors the performance and work quality from the supporting FNOL, SAT, and CPT teams to ensure their Adjudication team is receiving quality, timely work and assistance from these teams.Works with their, Director, Claims Adjudication Manager and FNOL, SAT, and CPT Team Managers to address issues and concerns as needed
• Involved in and assists with escalation management for their adjudication team and assists as a point of contact for issue identification and resolution for day-to-day problems that put customer/client experience at risk
• Reviews payment & denials that are over authorityandperforms claim signoffs on denied claims
• Communicates with customers, state insurance departments, the Combined Legal team and other internal and external areas. Has both technical and administrative responsibilities in file recreation and complaint handling (DOI/BBB)
• Monitor, report and respond to consumer social media complaints (Facebook, Glassdoor, Tweets, etc.)
• Identifies and recommends claims operational improvements to increase efficiencies
• Partners with and contributes to the department's success by being a technical expert in all systems/products and is utilized as a SME when called upon
• Suspends Payments
• Spot checks quality performance as needed (late notice, outpatient surgery, HCH reviews, etc.)
• Oversight in complex claims involving Legal, SIU, MD & Rescission
• Performs 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.
• ContinuousLearning: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
• ResultsOrientation: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
• ValuesOrientation: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

• Highly proficient in all aspects of claims adjudication, our products, and processes and procedures for the handling of A&H, CANCER, CI, DI & LIFE Claims.
• Able to lead a small team of claims Adjusters in support of the Adjudication Claims Manager
• Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges
• Analytical skill necessary to make decisions and resolve complex issues inherent in handling losses
• Ability to successfully negotiate the settlement and disposition of serious claims including the ability to interpret related documentation
• Demonstrate integrity with strong work ethic and customer centric focus
• Demonstrate active listening skills through effective use of questions, reflection, and empathy
• Lead and manage internal and external partners & provide guidance as a peer leader
• Help to maintain team performance and contribute towards process improvement within department
• Understands insurance and regulatory language
• Proficiency in Microsoft Word required
• Proficiency in MS Excel, PowerPoint, and Access preferred
• Bilingual (English/Spanish) is a plus
• Bachelor's degree or equivalent work experience

Education and Experience

• Bachelor's degree or equivalent work experience

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.

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