- Planning & Monitoring Process
- Develop best practices to optimize claim processing quality.
- Evaluate professional skills of claim staffs and provide appropriate claim assignments to them.
- Oversee medical, insurance and legal aspects of assigned claims. Interact with Claimant, Polices and others to ensure claim acceptance
- Assist in hiring and training new candidates in their job responsibilities.
- Monitor individual performance and ensure it meets expected quality and performance objectives.
- Develop professional development plans for employees to improve performance efficiency.
- Assist in employee performance evaluation, promotion, retention and termination activities.
- Operational Excellence Process
- Ensure that claim team follows state regulations and standard operating procedures.
- Resolve coverage issues and approve coverage denials.
- Assist claim personnel in coverage investigation, liability analysis and acceptance negotiation.
- Document claim assessment and filing activities accurately.
- Provide daily support to claim staff on claim managing and filing activities.
- Managing statistical data to ensure that claims met the desire turnaround times and Metrics.
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