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. Â
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:Â Â Â Â
- 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.
