Provider Claims Manager

Titles

Requirements

Job Description

Claims Manager

• Bachelor’s degree in any Medical field, Finance, Business Administration, Insurance, or a related field preferred.

• Leading a large multicultural team based in Dublin and working closely our Global offices to active the required departmental KPIs in line with orgnisation goals .

• Minimum of 8 years of experience in claims management or a related field, with at least 4 years in a leading role.

• Act as a liaison between the Global Management and the claims team, ensuring clear communication and alignment of objectives.

• Proven track record of effectively managing teams and achieving operational goals.

• Development and implementation of departmental strategies and goals.

• Strong leadership and team management skills.

• Provide regular updates and reports to the Regional Management on team performance, claims processing, and customer satisfaction.

• Excellent communication, negotiation, and interpersonal skills.

• Participate in strategic planning with clear decision-making processes.

• Analytical mind-set with the ability to interpret complex data and make data-driven decisions.

• Promote high performance culture and provide guidance, training, and mentorship to team members to enhance their skills and performance.

• Proficiency in claims management software and Microsoft Office Suite.

• Monitor team workload and ensure equitable distribution of tasks.

• Detail-oriented with strong organizational and time management skills.

• Review complex or escalated claims and provide guidance on claim determinations.

• Ability to work in a fast-paced environment and manage multiple priorities effectively.

• Resolve escalated customer inquiries and complaints regarding claims issues.

• Flexibility to adapt to changing business needs and work under pressure.

• Analyse claims data and performance metrics to identify trends and opportunities for process improvement.

• Legally permitted to work in the country of operations.

• Prepare and present reports on claims activities, outcomes, and key performance indicators (KPIs) to senior management.

• Utilize data analysis to drive strategic decision-making and optimize claims processes.

• Actively participate in various operational activities, outside of claims, to ensure that operational service delivery is coordinated to meet and exceed clients’ expectations.

• Assist in Developing and updating claims policies and procedures.

• Ensure team adherence to all regulatory and company guidelines.

• Prepare and present regular reports on claims activity, performance metrics, and trends.

• Analyse data to identify areas for improvement and implement corrective actions.

• Other Ad hoc duties as required.