Note: The job is a remote job and is open to candidates in USA. Aflac is a Fortune 500 insurance company and industry leader in voluntary insurance products. The Claims Operations Manager oversees daily claims operations, employees, workflow, quality, risk management, training, technology initiatives, budgeting, and customer satisfaction.
Responsibilities
- Manages the daily operations of the Claims business unit; manages employees and operations of the business unit at the functional level; gathers and analyzes data and reports that pertain to the overall operation of the Claims business unit and completes reports summarizing activities and trends; assists in strategic and tactical operational plans to ensure achievement of company and departmental goals; performs independent review of problem situations; develops solutions and implements actions to resolve problems and ensure customer satisfaction; reviews processes and procedures to streamline activities to enhance service turnaround time, productivity, and quality; coordinates overall workflow of the business unit and ensures that workflow processes facilitate effective and efficient use of corporate resources and enhance customer satisfaction
- Directs efforts to implement risk management and quality improvement initiatives; facilitates calibration sessions; uses methods such as work process studies, statistical analysis, and assessments of production area performance to establish adherence to quality standards/scorecards; remains abreast of industry trends and technology changes; incorporates best practices in the development of quality standards, policies, programs, and system changes for the department; ensures that claims are processed according to appropriate risk selection principles
- Coordinates and monitors training efforts to ensure that necessary education tools are provided to employees; identifies and communicates training needs and schedules with training department; projects staffing requirements for the business unit; guides supervisors in coaching and counseling employees; coordinates employee development and incentive initiatives
- Identifies, analyzes, and monitors business technology requirements and enhancement possibilities; recommends viable technological solutions, modifications, and applications; prepares recommendations for implementation of initiatives; takes a leadership role in managing assigned initiatives; participates in and supports companywide initiatives through Quality Circles, Focus Groups, or other project initiatives
- Monitors and controls operating expenses to ensure that corporate/divisional financial goals are met; provides input into the annual business unit budget; reviews legal files and coordinates with counsel to prepare for depositions and court hearings
- Performs other related duties as required
Skills
- • Worker Designation – This role is a remote role. This means you will be expected to work from your home, within the continental US
- • Broad knowledge of production management concepts, operating principles, and operational management methodology applicable to claims processing; a high degree of skill in applying this knowledge to the analysis and resolution of very complex or sensitive claims operational issues; ability to apply new developments and methodologies to direct the improvement in efficiencies
- • Broad knowledge of federal, state, and local regulatory and industry requirements, standard concepts, practices, and procedures as they relate to the insurance industry and claims processing
- • Knowledge of budgeting and expense control to plan, implement, and maximize expenditure of funds while maintaining and improving quality standards
- • Knowledge of employee relations to conduct and deal with employee issues in a proactive manner
- • Bachelor's Degree In Health Administration, Business, or a related field
- • 6 years of job-related work experience
- • 4 years in a leadership/senior/supervisory capacity
- •Or an equivalent combination of education and experience
- • Claims administration, or experience in a related field or industry
- • Insurance or other industry designations
Benefits
- Remote role, working from home within the continental US, with occasional office visits based on business need
- Medical, dental, and vision coverage
- Prescription drug coverage
- Health care flexible spending
- Dependent care flexible spending
- Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no costs to employee)
- 401(k) plans
- Annual bonuses
- An opportunity to purchase company stock
- 11 paid holidays annually
- Up to 20 days PTO to be used for any reason
- If eligible, state-mandated sick leave (Washington employees accrue 1-hour sick leave for every 40 hours worked)
- Other leaves of absence, if eligible, when needed to support your physical, financial, and emotional well-being
- Sick and safe leave, and adoption and parental leave, in all states and localities
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