Description

Pharmacists Mutual Insurance has an opening for a Professional Liability Claims Manager. This position will ensure superior delivery of claims services and products. The manager will also direct, coordinate, and monitor the activities of a team of claims employees and/or other parties assigned to manage the Company's claims, such as Third-Party Administrators and MGAs. The manager will provide consulting and training resources and serve as a contact and technical resource to external and internal business partners.  

Claims Manager 

•         Ensures timely and appropriate claim decisions and resolutions.
•         Engages with the Claims team leadership to develop and implement strategic programs that meet our Company's goals and objectives.
•         Assesses performance and growth needs of team members and engages in development discussions.

Essential Functions

Essential functions may include, but are not limited to the following:     

•         Timely decision making and action to meet Company guidelines and goals.
•         Provides quality customer service by monitoring performance and establishing metrics. 
•         Resolves complaints, problems, and coverage questions which have been escalated through the team.
•         Establishes focus of the team to properly manage Company indemnity & expenses. 
•         Recommends appropriate cases for discussion for claims roundtable; Attends and/or presents at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expenses. 
•         Ensures that the Company’s claim quality, guidelines and metrics are successfully met. 
•         Assigns staff to attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. 
•         Evaluates the work of assigned staff and prepares written performance evaluations; makes recommendations on personnel actions to include hiring, work assignments, training, and discipline.
•         Manages relationships with large accounts and brokers from a claims and risk management perspective.
•         Works with and manages a third party administrator and/or external business partners as applicable. 

Knowledge, Skills and Abilities:

•         Understand principles and practices of insurance claims examination.
•         Knowledge of employee management principles including hiring, supervision, training, retention, and performance evaluation.
•         Conduct investigative interviews. 
•         Understand employee management and developing standards.
•         Manage process, planning, and tracking of budgets.
•         Correct English usage, spelling, grammar, vocabulary and punctuation.
•         Ability and flexibility to work longer hours when workload fluctuations occur. 
•         Research and stay up-to-date with trends and changes in the claims/insurance industry. 
•         Communicate effectively with others (oral and written).
•         Analyze complex issues and make critical decisions.
•         Maintain records, prepare reports and conduct correspondence related to the work.
•         Interpret and apply laws, rules and regulation, as well as complex policy and contract coverage.
•         Obtain and use sensitive information discreetly and objectively, both internal and external.
•         Determine when to escalate concerns to the appropriate level of management.
•         Follow oral and written directions.
•         Work effectively with others in a team environment.
•         Contribute effectively to the accomplishment of team or work unit goals, objectives and activities.
•         Establish and maintain effective working relationships with those contacted in the course of work.
•         Excellent customer service skills. 
•         Ability to organize and prioritize work.
•         Work independently and demonstrate drive and initiative.
•         Ability to handle multiple tasks at once.
•         Ability to meet definite deadlines and deal with pressure situations.
•         Collect, interpret, and input data efficiently and accurately. 
•        Use computer and related software effectively.
•        Use Microsoft Office programs efficiently and effectively. 
•        Expertise in Workers Compensation, Property, Subrogation, Auto & General Liability or Professional Liability claims.

Requirements

Experience and Education Qualifications

Claims Manager

•         High School Diploma or equivalent and 15 years of related experience; or
•         Associate’s Degree and 12 years of related experience; and

        One of the following industry related certifications:  AIC (Associates in Claims, AIC-M (Associates in Claims-Management), AIM (Associates in Management), CRM (Certified Risk Manager), or SCLA (Senior Claim Law Associate)

OR

•         Bachelor’s Degree and 8 years of related experience; or
•         Master’s Degree and 5 years of related experience

Special Requirements, Licenses and Certificates

•         Licensing required in some states.

Preferred Qualifications

•         Advanced or specialized training/certifications preferred: SCLA, AIC, ARM, CPCU

Work Environment

•         Primary work environment is in a climate-controlled office setting
•         Work may involve travel to attend meetings at other locations