Description

Pharmacists Mutual Insurance has an opening for a 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 Examiners and/or Specialists. The manager will provide consulting and training resources, and serve as a contact and technical resource to the field and internal business partners.

Claims Manager

Learns how to make timely decisions, with guidance and direction from key stakeholders.
Engages with the Claims team leadership to develop and implement strategic programs that meet our Company's goals and objectives.
Learns different leadership styles and begins to develop own leadership style.
Learns how to assess performance and growth needs of team members and how to engage in development discussions.

Senior Claims Manager

Makes timely decisions, with guidance and direction from primary stakeholders.
Engages with the Claims team leadership to develop and implement strategic programs that meet our Company's goals and objectives.
Develops leadership style and motivates team to achieve a common goal by demonstrating the professional behaviors expected.
Learns to identify strengths and growth needs of team members and how to engage 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)

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

Senior Claims Manager

HS Diploma or equivalent and 20 years of related experience with at least 5 years in leadership; or
Associate's Degree or equivalent and 15 years of related experience with at least 3 years in leadership; and
One of the following industry related certifications: AIC-M (Associate in Claims- Management), AIM (Associate in Management), CRM (Certified Risk Manager), SCLA (Senior Claim Law Associate), CPCU (Chartered Property Casualty Underwriter)

Bachelor's Degree and 8 years of related experience with at least 2 years in leadership; or
Master's Degree and 6 years of related experience with at least 1 year in leadership

Special Requirements, Licenses and Certificates

Licensing required in some states.

Preferred Qualifications

Advanced or specialized training/certifications preferred: SCLA, AIC, ARM, CPCU

Work Environment

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

Benefits

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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