Claims Manager - Evernorth - Hybrid

POSITION SUMMARY

The Claims Manager is responsible for managing the day-to-day activities of claims supervisors, strategies, metric performance/quality expectations for an assigned claim platforms.

The claims manager will work very closely and collaboratively with many matrix partners to manage inventory, capacity, global service partners (GSPs), and peers to ensure competent and adequate staffing to achieve defined performance and quality metrics.

Primary Responsibilities


* Accountable for supervisor performance in managing claim advocates to drive and maintain claim inventory efficiently and accurately across multiple claim types.


* Manages overall operational performance through eMOS review of attainment and quality performance and development of action plans to remediate issues.


* Engages and communicates with matrix partners (e.g., RMG, capacity planning, GSPs, etc.) to develop strategic plans to increase performance and to remove operational challenges and barriers.


* Develops and fosters a positive team culture to drive results through communication, inclusion, engagement, and development of supervisors and direct reports.


* Leverages managerial courage in performance management discussions and consistently delivers accurate and transparent messages to staff


* Responsible for the strategic analysis of eMOS data to gain deep insights in order to proactively recommend improvements related to eMOS tools, team results and processes to drive operational efficiencies and improvements across aligned organization.


* Address eMOS findings at the team, cross team and organizational levels, working to remove barriers for individuals and beyond as a change leader to staff and matrix partners with regard to efficiency and quality.


* Accountable for meeting performance requirements in dedicated and performance guaranteed accounts, including accounts with late payment interest requirements


* Identify and facilitate mid to large scale operational improvement opportunities impacting quality, accuracy, and efficiency.


* Facilitates compliance with state regulations and (as applicable) SOX and SOC compliance requirements.


* Responsible for effectively communicating verbally and in writing to senior leaders in the organization and in disseminating information to staff.


* Providing mentoring and coaching to supervisors to meet or exceed goals successfully.

Key Qualifications


* High School Diploma or GED required; Bachelor's degree preferred.


* 5 years relevant operations experience


* 2+ years of supervisory experience, with a preference to supervising claims processors.

Leverage managerial courage through difficult employee performance and management situations.


* 2+ years of claims management experience, including auto-adjudication, quality, and/or metric score card management, with a preference to Management Operating Systems (eMOS) tools and methodologies.


* 2+ years ...