Review, assign and provide supervision of all claim activity for designated claims to ensure compliance with Corporate Claim Standards, client specific handling instructions and in accordance with applicable laws.
November 27, 2022
Maintains selected files on personal diary including all files reserved over $50,000, all subrogation files, all files with delayed or denied benefits, all files formally assigned to the SIU, and all files with unresolved coverage issues.
January 09, 2023
Makes recommendations to client as suggested by the claim status.
January 25, 2023
Leadership - Exhibits confidence in self and others.
February 05, 2023
Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control.
February 28, 2023
Monitors Rx POS and OON reviews by nursing staff for accuracy and compliance with formulary, ODG, and WC State Guidelines as applicable.
March 16, 2023
Performs quarterly audits of 10% of the open inventory of each claims specialist for the purpose of validating the accuracy and completeness of the claims management process as well as to identify opportunities for improving the process as well as the claim result.
March 28, 2023
