The Claims Review and Settlement Senior Manager oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Manages the operations of an insurance claims department to meet operational, financial, and service requirements. Being a Claims Review and Settlement Senior Manager assures timely and proper disposition of claims based on policy provisions. Manages appraisal and examination staff and processes. In addition, Claims Review and Settlement Senior Manager recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the value of settlements for escalated claims. Manages negotiations of settlements and administration of claims in litigation. Typically requires a bachelor's degree. Typically reports to top management. The Claims Review and Settlement Senior Manager typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Working as a Claims Review and Settlement Senior Manager typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments.
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The Claim Review and Settlement Manager oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Manages the operations of an insurance claims department to meet operational, financial, and service requirements. Being a Claim Review and Settlement Manager assures timely and proper disposition of claims based on policy provisions. Manages appraisal and examination staff and processes. In addition, Claim Review and Settlement Manager recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the value of settlements for escalated claims. Manages negotiations of settlements and administration of claims in litigation. Typically requires a bachelor's degree. Typically reports to top management. The Claim Review and Settlement Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Working as a Claim Review and Settlement Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes.
Medical Claims Review Manager oversees the performance, productivity, and quality of the medical claims review staff. Responsible for hiring, training, and firing medical claims review staff. Being a Medical Claims Review Manager evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Additionally, Medical Claims Review Manager typically requires an RN or BSN. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Claims Review Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Claims Review Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required.
The Claim Review and Settlement Examiner I examines and authorizes insurance claims investigated by insurance adjusters. Reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Being a Claim Review and Settlement Examiner I communicates with agents, claimants, and policy holders. Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. In addition, Claim Review and Settlement Examiner I determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. Being a Claim Review and Settlement Examiner I work is closely managed. Works on projects/matters of limited complexity in a support role. Working as a Claim Review and Settlement Examiner I typically requires 0-2 years of related experience.