Sr Manager, Claims

Sr Manager Claims

Remote

AMSURG is a nationally recognized leader in the strategic and operational management of ambulatory surgery centers with medical specialties ranging from gastroenterology to ophthalmology and orthopedics. With more than 250 surgery centers across the U.S., we partner with physicians and health systems to deliver the highest standards of patient care and quality.  For more information, please access our website: https://www.amsurg.com/.

Through AMSURG, our clinician-led organization is changing the face of healthcare by delivering high-quality care that puts the patient first.

Benefits:

At AMSURG, we offer benefits at the speed of your life. Our wide range of health and welfare benefits allow you to choose the right coverage for you and your family. Qualifying employees are eligible to enroll on the 1^st of the month, following 30 days of employment. AMSURG offers a variety of health and welfare benefit options to help protect your health and promote your wellbeing. Benefits offered include but are not limited to: Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA, Limited Healthcare FSA, FSAs for Transportation and Parking & HSAs, and a matching 401(K) Plan.

Paid Time Off:

AMSURG offers paid time off, 9 observed holidays, and paid family leave. You accrue Paid Time Off (PTO) each pay period and depending on your position and can earn a minimum of 20 days and up to 25 days per calendar year.

Summary:

The Sr. Manager of Claims is responsible for the strategic leadership and management of all claims within AMSURG. This position oversees the end-to-end claims processing cycle, ensures adherence to regulatory standards, implements best practices, and drives operational excellence. The Sr. Manager of Claims collaborates with internal teams, external stakeholders, and leadership to optimize processes and achieve organizational goals.

This position manages the claims function within the Risk Management department with respect to Workers’ Compensation (40%), General Liability (20%), Property (30%), and Professional Liability claims (10%) as well as other coverages if necessary. This includes reviewing incidents for reporting, notifying carriers after assessing potential liabilities, and managing the claim through all stages of litigation.

This is a remote first work schedule: Teammates may work from anywhere in the country.

ESSENTIAL RESPONSIBILITIES:

• Reviews all reported incidents in the AMSURG Incident Reporting System to identify potential claims, as well as claims severity. Verify insurance coverages and insurance carriers to be able to properly notify the carriers after evaluating facts and circumstances related to the incidents. Obtain written verification of reported claims to complete the process.
• Oversees the entire claims lifecycle, from submission to adjudication and eventual resolution. Ensures accurate and timely processing of claims.
• Works directly with insurance adjusters and defense counsel to ensure best defense and outcome of claims, and proactively assists in defense strategies.
• Develops and executes the strategic vision for the Risk department, aligned with organizational objectives.
• Provides leadership and direction, fostering a culture of continuous improvement and high performance.
• Investigates reported claims to determine compensability of such claims and handles matters within their authority to include the execution of releases and payments in conjunction with the insurance carriers and/or the Director of Claims.
• Handles subpoenas and requests for medical records.
• Communicates effectively with internal/external stakeholders.
• Stays abreast of changes in healthcare regulations to ensure the claims process complies with industry standards and legal requirements.
• Provides guidance to Corporate and Center staff with respect to claim-related issues. Examples include locating approved clinics for injured employees and ensuring the Return-to-Work program is being implemented.
• Collaborates with internal departments such as Finance, Legal, IT, and Operations to ensure seamless integration of claims process.
• Develops and prepares claims reports and analyses from the data contained in the Claims system. Reports required on at least a quarterly basis.
• Analyzes claims data to identify trends, patterns, and areas for improvement.
• Obtains and formats information from carriers’ loss runs for third-party carriers in accordance with GAAP reporting. Reports completed on a quarterly basis for VP, Financial Reporting.
• Adheres to all company policies and procedures, including Information Security Policies and ensure that AMSURG remains as secure as possible.
• Regular and reliable attendance is required.

KNOWLEDGE AND SKILLS:

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily.  The requirements listed below are representative of the knowledge, skills and/or abilities required:

• Basic knowledge of claims processes is required to handle matters (both litigated and non-litigated).
• Understanding of reserve setting, claim finances, and loss run data analytics.
• Strong knowledge of state or federal regulations and/or statutes regarding insured claims preferred.

Education and Experience Requirements:

• Bachelor’s Degree from an accredited College or University.
• Minimum of eight (8) years of insurance/claims experience and other legal experience.
• Insurance industry designation(s) also highly preferred.

Technical Knowledge and Software Requirements:

• Expert in Microsoft Excel
• Experience with financial reporting systems is required.
• Ability to work with web-based claims management system and prepare reports.

OTHER QUALIFICATIONS:

Must be able to handle multiple, simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner. Must be able to work well with others. Strong verbal and written communication skills. Must be detail oriented and organized. High integrity, including maintenance of confidential information. Must be able to exercise good judgment. Based on business need, the ability to work a flexible schedule, including some evenings and weekends as approved in advance. Must pass a background check and drug screen.

COMPENSATION:

Please note, this position is remote. The pay range is dependent upon experience and, as presented, is specific to the market in Nashville, TN. Salary bands across AMSURG may differ due to cost-of-living adjustments and are specific to an employee’s address and relevant experience. 

Nashville area salary range: $79,715K - $105,000K with a 10% STI Plan.

We are an Equal Opportunity Employer.

We do not discriminate in practices or employment opportunities on the basis of an individual's race, color, national or ethnic origin, religion, age, sex, gender, sexual orientation, marital status, veteran status, disability, or any other prohibited category set forth in federal or state regulations.

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