Plans, leads, organizes and manages activity in the Reliance Standard Claims Medical Unit and is ultimately responsible for the quality of work, productivity, and customer service provided by the unit. The manager provides technical direction and assistance to all unit employees as well as any independent contractors performing medical services on behalf of the company. Monitors trends and developments in all areas of responsibility and provides training, mentoring and coaching as appropriate.
Duties and Responsibilities:
Manages the review of all medical and other documentation in claim records to answer the specific medical questions posed by claims examiners, supervisors and managers.
Manages the negotiation of service rates with medical vendors, ensures that appropriate vendor agreements have been signed, and ensures and the vendor is appropriately licensed and insured.
Performs key role in staff assessment, selection, development, skills training, teamwork and application of new processes and technology.
Ensures performance requirements and core competencies are communicated and satisfied through clear and consistent communication.
Conducts routine audits and/or oversees the audits of medical reviews for clarity, grammar, and coherence to non-medical personnel.
Provides regular feedback to staff regarding performance and developmental opportunities.
Completes, in a timely manner, annual performance reviews with an accurate assessment of employees’ performance
Oversees negotiation of service rates with medical vendors, ensures that the appropriate vendor agreement has been signed, and ensures that the vendor is appropriately licensed and insured.
Suggests improvements to processes, procedures and products as appropriate.
Assumes day-to-day assignment and distribution of workload subject to consultation with the AVP.
Tracks monthly unit activity.
Monitors expenses and assists in review of budget.
Submits yearly report of all medical activity based on monthly reports.
Provides consultation to Claims Department to assist facilitation of joint projects designed to maximize appropriate use of medical staff. May include creation and supervision of special projects.
Assists the Marketing Department by assisting in the response to Request for Proposals and by participating in sales presentations as necessary.
May testify in legal proceedings
All other duties as assigned.
BSN degree required.
Minimum of 2 years of related experience required.
Registered nurse with current state licensure required.
Strong clinical or case management background desirable.
Experience with the processing of insurance claims desirable. Experience with the handling of long term disability claims or integrated disability claims helpful.
Proven ability to work well in a high visibility, public oriented environment, with excellent written and verbal communication skills.
Demonstrated ability to work independently and ability to complete tasks with minimum amount of supervision.
Demonstrated aptitude in leadership skills.
Proven ability to work with the following equipment: P.C. (including Word and Excel), telephone, fax machine, calculator.
Prior experience using an automated claim system desirable.
Some travel may be required
Internal Number: 12019
About Reliance Standard
In business for over 100 years, Reliance Standard Life Insurance Company (Reliance Standard) is a leading insurance carrier specializing in innovative and flexible employee benefits solutions including disability income and group term life insurance, dental insurance, critical illness and accident insurance. Reliance Standard offers a complete suite of voluntary (employee paid) coverage options and services, as well as fully integrated absence management services. Our products and services are marketed through independent brokers and agents to employers of all sizes.
Reliance Standard Life Insurance Company is a member of the Tokio Marine Group. The Tokio Marine Group operates in the property and casualty insurance, reinsurance and life insurance sectors globally. The Group’s main operating subsidiary, Tokio Marine & Nichido Fire (TMNF), was founded in 1879 and is the oldest and largest property and casualty insurer in Japan.