Third Party Claims Supervisor

JOB SUMMARY:

A Third-Party Claims Supervisor is responsible for overseeing a team of claim representatives and claim specialists who manage claims made by individuals or entities against our clients. The core objective is to ensure that claims are handled accurately, efficiently, and in compliance with all relevant laws, regulations, and company policies, while also providing excellent customer service and team leadership.

ESSENTIAL DUTIES & RESPONSIBILITIES:

Includes, but is not limited to, the following:

• Team Supervision and Management: Supervise and manage a team of claims adjusters/specialists, including hiring, training, mentorship, coaching plans and performance evaluations.
• Claims Oversight: Oversee the start-to-end claims process, including intake, investigation, evaluation, negotiation, and settlement of claims.
• Quality Assurance & Compliance: Conduct regular quality audits of staff work to ensure compliance with company policies, procedures, and all applicable state and federal regulations.
• Complex Claim Resolution: Act as an escalation point for complex or contentious claims, assisting staff with coverage investigations, liability analysis, and settlement negotiations.
• Workflow & Efficiency: Monitor team workloads, manage diaries, and implement process improvements to optimize performance, productivity, and customer satisfaction.
• Communication & Reporting: Serve as a liaison between the company, clients, claimants, attorneys, and other third parties. Prepare and present reports on claim metrics, trends, and operational performance to management.
• Reserve Management: Ensure the appropriate and timely establishment and adjustment of claim reserves to reflect potential exposure.
• Litigation Support: Coordinate with the client, legal counsel and third-party administrators (TPAs) on litigated claims.
• Fraud Detection and Prevention: Monitor claims to identify potential fraud, referring suspicious activities to appropriate authorities and/or management.
• Data Analysis and Trend Identification: Analyze claims data and statistics to identify patterns, trends, and areas for process improvements or risk management strategies for clients and internal departments.
• Vendor and Service Partner Management: Manage relationships with external service providers such as independent adjusters, appraisers, and contractors, ensuring quality and cost-effectiveness of their services.
• Client Relationship Management (for TPAs): Serve as a primary point of contact for self-insured clients, providing detailed reports, participating in client reviews, and ensuring service level agreements (SLAs) are met.
• Mentorship and Professional Development: Create professional development plans for employees, provide ongoing technical advice and guidance to staff, and assist with their performance evaluations, promotion, retention, and termination activities.
• License Tracking and Record Keeping: Maintain an accurate and up-to-date database or system of all required department, facility, or individual employee licenses, permits, and certifications. This includes tracking expiration dates, status, and related documentation.
• Maintaining Licensing: Maintain insurance adjuster licensing as required in all states.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

EDUCATION and/or EXPERIENCE:

High School Diploma/GED: This is the basic minimum requirement for entry-level claims roles.

• Associate's or Bachelor's Degree: Most employers prefer candidates with a degree in Business Administration, Finance, Risk Management, Insurance, or a related field.
• Prior Claims Experience: A minimum of 2-5 years of technical experience in claims processing or adjusting is typically required. This experience should ideally involve handling complex or litigated claims, coverage investigations, and liability analysis.
• Supervisory/Leadership Experience: Previous experience in a supervisory, team lead, or mentorship role is highly preferred, demonstrating an ability to guide and manage a team.
• Industry-Specific Knowledge: Strong knowledge of specific claim types (e.g., general liability, commercial auto, property and casualty) and related regulations is essential.

LICENSING:

• Ability to obtain and maintain insurance adjuster licensing as required in all states.

ORAL COMMUNICATION SKILLS:

• Active Listening: This is arguably the most important skill. It involves fully concentrating on what is being said, understanding the message, and paying attention to non-verbal cues. This helps in collecting accurate information, showing empathy, and ensuring all parties feel heard.
• Clarity and Conciseness: The ability to convey complex information, such as insurance policies or claim decisions, in simple, straightforward language is crucial. Avoiding industry jargon and getting straight to the point prevents misunderstandings and saves time for all involved.
• Empathy and Emotional Intelligence: Claims often involve sensitive situations or frustrated individuals. Displaying empathy-acknowledging and sharing the feelings of others without necessarily agreeing with their position-helps de-escalate conflict and builds rapport.
• Tone, Volume, and Pacing: How you speak is as important as the words you use. A calm, confident, and respectful tone helps build credibility and ensures the message is received as intended, especially during difficult conversations. Pacing your speech to avoid talking too quickly also helps the listener process information.
• Confidence: Speaking with assurance demonstrates professionalism and competence. This doesn't mean being overbearing, but rather being prepared and assertive, which helps gain the trust of clients, team members, and management.
• Audience Awareness and Adaptability: Different situations and people require different communication styles. A conversation with a C-level executive might be formal and data-focused, while a discussion with a frustrated claimant might require a more patient and empathetic approach.
• Negotiation and Conflict Resolution: A claims supervisor frequently engages in negotiations and manages disagreements. Strong oral skills enable effective persuasion, working toward agreements, and resolving divergent interests in a constructive manner.
• Non-Verbal Communication: Body language, facial expressions, and eye contact play a significant role in communication. Maintaining appropriate eye contact and an open posture conveys engagement and honesty, while a lack of eye contact can imply disinterest or untrustworthiness.
• Giving and Receiving Feedback: Both providing constructive feedback to team members and accepting criticism from superiors or clients are vital. This fosters a culture of continuous improvement and open dialogue within the department.

PREFERRED KNOWLEDGE, COMPENTENCIES & SKILLS:

• Leadership and Management: The ability to motivate, train, and mentor a team effectively, manage performance, and resolve conflicts.
• Analytical and Problem-Solving Skills: Essential for evaluating complex claims, identifying discrepancies, and making sound, data-driven decisions.
• Communication Skills: Excellent verbal and written communication skills are crucial for interacting with claimants, clients, legal counsel, and senior management.
• Attention to Detail: Meticulousness in reviewing documents, policy language, and regulations is vital to prevent errors and ensure compliance.
• Negotiation Skills: Strong ability to negotiate settlements effectively with various parties, including attorneys.
• Technical Proficiency: Competency with claims management software/systems (e.g., Guidewire, Duck Creek), Microsoft Office Suite (especially Excel for data analysis), and data analysis tools.
• Regulatory Knowledge: In-depth understanding of relevant state and federal insurance regulations and compliance standards.
• Deep Industry Knowledge: Comprehensive understanding of the insurance industry, including property & casualty, general liability, commercial auto, and workers' compensation lines of business.
• Claims Management Methodologies: Knowledge of best practices for claims investigation, evaluation, negotiation, subrogation, and resolution processes, including fraud detection techniques.

MATHEMATICAL SKILLS:

• Basic Arithmetic and Calculation: The ability to perform fundamental operations (addition, subtraction, multiplication, division) quickly and accurately is essential for calculating damages, reviewing invoices, verifying expenses, and processing payments.
• Estimation: Using available data to estimate the potential future cost of a claim (setting reserves).
• Projections: Forecasting potential claim outcomes based on historical data and current trends.
• Metrics Review: Analyzing performance metrics, such as claim frequency, severity, closure rates, and loss ratios.
• Statistical Comprehension: Understanding basic statistics used in reports (e.g., averages, medians, percentages) to make informed decisions.
• Attention to Detail and Accuracy: Ensuring all calculations are performed without error is critical. A simple mistake in a calculation can lead to underpayment of a claimant, resulting in litigation, or overpayment of a claim, leading to financial loss for the company.

Physical Demands and Working Conditions

The worker is subject to inside environmental conditions: Protection from weather conditions but not necessarily from temperature changes.

The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading..

Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Talking: Expressing or exchanging ideas by means of the spoken word; those activities where detailed or important spoken instructions must be conveyed clearly and understandably both in person and over telephone.

Hearing: Perceiving the nature of sounds at normal speaking levels with or without correction, and having the ability to receive detailed information through oral communication, and making fine discriminations in sound.

Repetitive motions: Making substantial movements (motions) of the wrists, hands, and/or fingers.

WORK SCHEDULE

• Flexible work arrangements available, two business days remote work after training completion.
• Standard schedule: Monday through Friday, 8:00AM - 5:00PM.

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