What are the responsibilities and job description for the Director, Claims - Arizona position at AGIA?
Why AGIA?
AGIA Affinity is a growing insurance and member benefits marketing and administration partner to some of the largest and most iconic associations and organizations in the country. Based in California, we have long sought to improve the lives of not only our client members but our internal members as well.
We offer vacation, sick time, health benefits (medical, dental, vision), 401K with company match, remote work schedules, and 13 paid and closed holidays.
Enjoy working alongside a tenured team building our industry knowledge and forging new best-practices.
What Will You Do?
AGIA Affinity is a growing insurance and member benefits marketing and administration partner to some of the largest and most iconic associations and organizations in the country. Based in California, we have long sought to improve the lives of not only our client members but our internal members as well.
We offer vacation, sick time, health benefits (medical, dental, vision), 401K with company match, remote work schedules, and 13 paid and closed holidays.
Enjoy working alongside a tenured team building our industry knowledge and forging new best-practices.
What Will You Do?
The Director of Claims is the steward of an excellent customer experience when a claim event arises. This position is responsible for providing comprehensive leadership and management of AGIA’s life, accident and health claims staff including case management, adjudication and ensuring compliance with insurance carrier and client expectations and service standards. The Director of Claims provides technical guidance to Claims staff and closely monitors the achievement of internal quality metrics and departmental goals within the allocated budget.
Essential Job Functions
- Oversee the Claims functions to ensure carrier compliance, service, quality (monetary and statistical), cost and profit objectives are achieved and maximized.
- Deploy a responsive staffing model to effectively manage claim case management and adjudication volumes based on historical trends and/or anticipated claim submission activity.
- Continually evaluate and identify improved methods for handling claims to minimize risk and maximize claim workflow efficiency.
- Develop and maintain staff performance programs that reinforce an excellent customer experience, productivity, quality and cost containment.
- Manage Claims function performance to achieve “no exception” carrier audit results year over year.
- Oversee responses to complaints and/or escalated issues from carriers, clients, members and other affected parties. Consult with department leaders to develop 3, 6, 9, and 12-month carrier compliance and improvement strategies and measure improvement from baseline performance.
- Generate, disseminate and use data and reports to monitor claim inventories and quality/compliance performance.
- Run reports and analyze data to determine if anomalies are occurring
- Plan, organize and take action to resolve anomalies.
- Evaluate action plans to ensure successful implementation and results.
- Monitor progress of implemented solutions.
- Disseminate reports and data as needed.
- Oversee AGIA quality assurance programs for the Claims Department to achieve individual performer excellence and achieve expected corporate, client and carrier quality standards.
- Identify key performance indicators that require improvement.
- Manage all direct reports’ responsibilities as outlined in the job descriptions and corresponding performance metrics and standards to deliver expected results.
- Discuss error results with management and processing staff and identify corrective action.
- Translate errors into coaching, training and performance improvement solutions.
- Oversee the proper implementation and adherence to compliance directives and company security and privacy policies by the Claims team.
- Properly implement compliance directives generated by insurance carriers or government agencies.
- Provide corresponding documentation to Performance Improvement/Training for inclusion in training curriculums and corporate knowledge management solution.
- Oversee claims are paid in accordance with filed master policy contracts and in accordance with TPA administrative and regulatory requirements and guidelines.
- Work cross functionally to identify root causes of local defects or operational errors and continuous improvement opportunities. Identify and communicate escalated “hot spots” before they become high risk issues.
- Align areas of responsibility with corporate strategy and objectives to promote efficiency and optimize productivity.
Identify and prioritize opportunities for improvement within each functional area of responsibility. - Lead direct reports to contribute to the company's overall strategy by consistently communicating the vision and taking action to support and provide deliverables on company projects and activities.
- Build partnerships with peers and leadership to work collaboratively across divisions and to drive accountability, best practices and achievement of company projects and exceptional customer service.
- Measure progress and modify plans to ensure results meet delivery timelines and requirement expectations and are tied to company objectives.
- Support and promote an organizational culture that demands continuous improvement and individual and team accountability real time.
- Align areas of responsibility with corporate strategy and objectives to promote efficiency and optimize productivity.
- Provide leadership to staff to develop high levels of performance and team engagement while delivering quality results in established timelines.
- Coach, develop and guide direct reports to manage responsibilities, adhere to professional and industry best practices, and deliver expected results.
- Provide guidance, feedback and prioritization of projects and daily activities to support and foster high performing associates and teams to consistently meet internal and external customer expectations.
- Provide performance feedback to all direct reports on a monthly, quarterly and annual basis.
- Create development plans with associates to engage in continuing education to ensure skills and abilities keep pace with business requirements and needs.
- Develop and maintain policy and procedural documentation for every key functional responsibility.
- Manage divisional activities to mandated budgets and achieve CFO approved capital investment ROI performance targets or benchmarks for assigned projects and areas of responsibility.
- Develop and execute remediation plans when actual performance is below target.
- Lead divisional budget development and monthly maintenance while adhering to annual budget.
- Report budget vs. actual deviations and recommendations for how to respond to deviations to stated CFO performance criteria.
- Perform other miscellaneous functions and special projects as assigned.
Qualifications
- Minimum five years of insurance administration experience.
- Minimum five years of claims and/or insurance operations leadership experience.
- Minimum two years of Life, Accident and Health product line processing experience.
- Budget and capacity management experience.
- Underwriting experience preferred.
- SQL database and queries experience preferred.
- Knowledge of life, accident and health claims product lines, processes, terminology, state regulations and best practices.
- Lean Kaizen or quality and process improvement programs desired.
- Multiple administrative systems desired.
Independent Insurance Claims Adjuster in Casa Grande, Arizona
MileHigh Adjusters Houston Inc -
Casa Grande, AZ
Independent Insurance Claims Adjuster in Fountain Hills, Arizona
MileHigh Adjusters Houston Inc -
Fountain, AZ
Independent Insurance Claims Adjuster in Temple, Arizona
MileHigh Adjusters Houston Inc -
Temple, AZ