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Hybrid Claims Manager - Professional Liability (Medical Malpractice - Pharmacy, Dental and Vet) presso PHARMACISTS MUTUAL INSURANCE CO

PHARMACISTS MUTUAL INSURANCE CO · Algona, Stati Uniti d'America · Hybrid

93.000,00 USD  -  115.000,00 USD

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Job Details

Job Location:    ALGONA HWY 18 HOME OFFICE - ALGONA, IA
Position Type:    Full Time
Salary Range:    $93000.00 - $115000.00 Salary

Description

Pharmacists Mutual Insurance has an opening for a Professional Liability Claims Manager. This position will ensure superior delivery of claims services and products. The manager will also direct, coordinate, and monitor the activities of a team of claims employees and/or other parties assigned to manage the Company's claims, such as Third-Party Administrators and MGAs. The manager will provide consulting and training resources and serve as a contact and technical resource to external and internal business partners.  

Claims Manager

  • Ensures timely and appropriate claim decisions and resolutions.
  • Engages with the Claims team leadership to develop and implement strategic programs that meet our Company's goals and objectives.
  • Assesses performance and growth needs of team members and engages in development discussions.

Essential Functions

Essential functions may include, but are not limited to the following:    

  • Timely decision making and action to meet Company guidelines and goals.
  • Provides quality customer service by monitoring performance and establishing metrics.
  • Resolves complaints, problems, and coverage questions which have been escalated through the team.
  • Establishes focus of the team to properly manage Company indemnity & expenses.
  • Recommends appropriate cases for discussion for claims roundtable; Attends and/or presents at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expenses.
  • Ensures that the Company’s claim quality, guidelines and metrics are successfully met.
  • Assigns staff to attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
  • Evaluates the work of assigned staff and prepares written performance evaluations; makes recommendations on personnel actions to include hiring, work assignments, training, and discipline.
  • Manages relationships with large accounts and brokers from a claims and risk management perspective.
  • Works with and manages a third party administrator and/or external business partners as applicable.

Knowledge, Skills and Abilities

  • Understand principles and practices of insurance claims examination.
  • Knowledge of employee management principles including hiring, supervision, training, retention, and performance evaluation.
  • Conduct investigative interviews.
  • Understand employee management and developing standards.
  • Manage process, planning, and tracking of budgets.
  • Correct English usage, spelling, grammar, vocabulary and punctuation.
  • Ability and flexibility to work longer hours when workload fluctuations occur.
  • Research and stay up-to-date with trends and changes in the claims/insurance industry.
  • Communicate effectively with others (oral and written).
  • Analyze complex issues and make critical decisions.
  • Maintain records, prepare reports and conduct correspondence related to the work.
  • Interpret and apply laws, rules and regulation, as well as complex policy and contract coverage.
  • Obtain and use sensitive information discreetly and objectively, both internal and external.
  • Determine when to escalate concerns to the appropriate level of management.
  • Follow oral and written directions.
  • Work effectively with others in a team environment.
  • Contribute effectively to the accomplishment of team or work unit goals, objectives and activities.
  • Establish and maintain effective working relationships with those contacted in the course of work.
  • Excellent customer service skills.
  • Ability to organize and prioritize work.
  • Work independently and demonstrate drive and initiative.
  • Ability to handle multiple tasks at once.
  • Ability to meet definite deadlines and deal with pressure situations.
  • Collect, interpret, and input data efficiently and accurately.
  • Use computer and related software effectively.
  • Use Microsoft Office programs efficiently and effectively.
  • Expertise in Workers Compensation, Property, Subrogation, Auto & General Liability or Professional Liability claims.

Qualifications


Experience and Education Qualifications

Claims Manager

  • High School Diploma or equivalent and 15 years of related experience; or
  • Associate’s Degree and 12 years of related experience; and
  • One of the following industry related certifications:  AIC (Associates in Claims, AIC-M (Associates in Claims-Management), AIM (Associates in Management), CRM (Certified Risk Manager), or SCLA (Senior Claim Law Associate)

OR

  • Bachelor’s Degree and 8 years of related experience; or
  • Master’s Degree and 5 years of related experience

Special Requirements, Licenses and Certificates

  • Licensing required in some states.

Preferred Qualifications

  • Advanced or specialized training/certifications preferred: SCLA, AIC, ARM, CPCU
  • Professional Liability background, specifically medical malpractice to include Dental, Pharmacy, and/or Veterinary.

Work Environment

  • Primary work environment is in a climate-controlled office setting
  • Work may involve travel to attend meetings at other locations

In addition to a competitive salary, eligible employees may receive an annual discretionary bonus and access to our benefits package including:

  • Health, Dental, Vision & Life coverage
  • 401(k) with Company Match
  • Paid Time Off
  • 8 Paid Holidays
  • Volunteer Time Off
  • Paid Parental Leave
  • Hybrid/Remote Work Options
  • Employee Assistance Program
  • Tuition Reimbursement

Pharmacists Mutual Insurance Group is an Equal Opportunity Employer.

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