Medical Claims Review Manager jobs in Connecticut

Company Details

"Our Company provides a state of predictability which allows brokers and agents to act with confidence."

Founded in 1967, W. R. Berkley Corporation has grown from a small investment management firm into one of the largest commercial lines property and casualty insurers in the United States.

Along the way, we’ve been listed on the New York Stock Exchange, become a Fortune 500 Company, joined the S&P 500, and seen our gross written premiums exceed $10 billion.

Today the Berkley brand comprises more than 50 businesses worldwide and is divided into two segments: Insurance and Reinsurance and Monoline Excess. Led by our Executive Chairman, founder and largest shareholder, William. R. Berkley and our President and Chief Executive Officer, W. Robert Berkley, Jr., W.R. Berkley Corporation is well-positioned to respond to opportunities for future growth.

The Company is an equal employment opportunity employer.

Responsibilities

Lead and coordinate claim operational reviews of WRBC’s operating units. Communicate and collaborate with corporate level constituents both prior to reviews to obtain relevant information and at the conclusion of reviews to debrief and report results.

Key Functions/Duties of Position:

Responsibilities:

• Staffing and planning the review (reviews are staffed with claim professionals from WRBC operating units).
• Interviewing departmental personnel and senior management.
• Coordinating the work of the review team members.
• Assessing the practices, procedures, and results of the subject department.
• Assessing the effectiveness of the organizational structure, staffing, and management information.
• Identifying improvement opportunities and developing potential solutions. 
• Coordinating with colleagues in IT, Finance and Underwriting to deliver a unified message to the operating units.
• Leading closing meetings and delivering feedback.
• Preparing the written report and recommendations.
• Following up on implementation of recommendations.
• Participating in annual risk assessment to help develop an annual audit plan.

Qualifications

Education Requirement:

• Four (4) year College Degree, or commensurate experience and training

Qualifications: 

Experience:

• Seasoned commercial P&C insurance professional (over 10 years)
• Must have handled claims, managed claims professionals and lead claim audits.
  • Claims expertise
    • Leading claims audits.
    • Involved in quality assurance initiatives.
    • Handling of diverse claims.
    • Managed claims professionals
    • Developed and monitored best practices, guidelines, and management metrics.
    • Involved in vendor management.
    • Managed litigated claims portfolio.
  • Diversified insurance experience
    • Primary insurance
    • Admitted and non-admitted
    • Standard lines and specialty lines

Skills and characteristics:

• Strong leader and manager - able to manage a diverse group of team members.
• Presence to and experience in dealing with senior management.
• Effective at relationship building, influencing, and persuading.
• Strong project management and organizational skills.
• Ability to work independently with a strong work ethic.
• Good communicator (verbal and written).
• Willing to roll up sleeves and do all aspects of the review work.
• Assertive yet flexible and open minded.
• Excellent computer and data analysis skills.
• Improve, automate, and standardize the review process through innovation.
• Work in an environment with no administrative support.

Additional Requirements