Head of Employee Benefits Claims Management

6 days ago


New York, New York, United States WTW inc. Full time

Job Summary

The Head of Employee Benefits Claims Management at WTW inc. is responsible for overseeing the entire claims process for employee benefits, ensuring that claims are processed efficiently and fairly. This includes working with insurance carriers to expedite claims resolution and ensure compliance with policy terms.

Key Responsibilities

  • Lead the claims team responsible for employee benefits claims, managing staff performance, providing guidance, and ensuring the department meets service level agreements and regulatory standards.
  • Oversee the entire claims process for employee benefits, ensuring that claims are processed efficiently and fairly.
  • Serve as the main point of contact for employers regarding claims issues, providing expert advice on claims-related inquiries and working to resolve any client concerns.
  • Handle complex or escalated claims, negotiating with insurers, healthcare providers, and legal teams when necessary.
  • Ensure that all claims handling complies with local regulations and other relevant laws, staying updated on regulatory changes affecting employee benefits claims.
  • Provide regular reports to clients on claims performance, identifying trends and making recommendations for improvement.
  • Work closely with the benefits consulting and underwriting teams to provide insights on claims experience, assist with renewal negotiations, and help tailor benefits packages based on claims trends.
  • Build and maintain relationships with insurers and third-party administrators (TPAs) to ensure efficient claims handling and resolution.
  • Assist employers in understanding the claims process and their employees' benefits, providing training or materials to help them navigate the system effectively.
  • Continuously review and improve the claims handling processes to enhance client satisfaction and operational efficiency.

Requirements

  • Min. Bachelor's Degree
  • Microsoft Office literacy
  • Min. 3 years working experience at similar role in Insurer's Claim Department, Third Party Claim Settlement Company
  • Good communication & problem solving skills
  • Client-oriented, innovative and critical sense
  • Good presentation and negotiation skill
  • High integrity
  • Be able to work under high pressure
  • Long-term commitment
  • Excellent English in both writing and oral


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