1214782 - Claims Supervisor

Job Description Template-General

Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world.  Organic growth and over 60 successful acquisitions have grown our 2022 Gross Written Premium (GWP) to $5 Billion.  Our workforce has grown to 4,300 worldwide … big, but not so big that you cannot make a difference.  Our Good Company values, including integrity, empowerment, and commitment to customer service, and a culture of innovation, communication, and collaboration make TMHCC a great place to work. 

TMHCC Stop Loss, a $2 Billion division within TMHCC, leads the way in providing medical stop loss insurance sold to employers. Medical Stop Loss provides an added layer of insurance protection to employers who choose to self-fund their health benefit plans. Self-funding can incur risks from catastrophic claims, and Medical Stop Loss insurance from Tokio Marine HCC is designed to protect employers from that risk. 

*This role is located onsite in Kennesaw, GA*

Position Summary:

Supervises a team of Claims Auditors in the investigation of claims liability and the extent of the liability of submitted claims. Ensures timely accurate processing of claims according to exiting policies and/or contracts.

Key Responsibilities:

• Ensure the efficient operation of the Claims department through supervision of Claims Auditors.

• Direct Claims Auditors in resolving problems, making lower-level decisions, releasing over-limit claims, and handling the proper contractual disbursement of excess loss claims.

• Educate and train colleagues and team members in the duties and responsibilities of strong Claims practices. Promote independent thinking based on sound judgment and decisions. Promote Business Unit procedures and philosophies to clients and staff.

• Access in-house resources including Actuarial, Underwriting, and Marketing departments to assist in attaining business goals.

• Manage the work flow of the Auditors.

• Understand and interpret employer plans of health coverage and excess insurance policy.

• Identify and initiate large-case management, reserve maintenance, and bordereaux reporting.

• Communicate in writing and verbally with Third-Party Administrator (TPA)/client as needed, including resolving complex problems of a TPA/client.

• Set claims reserves and adjust as needed.

• Issue checks for amount of liability, communicates to TPA/client reasons for any amounts not covered by excess policy.

• Maintain quality, quantity, and turnaround time standards of department and company.

Education, Experience & Knowledge:

• Possess and have ability to apply broad knowledge of principles, practices, and procedures

• Excellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacy

• Exceptional organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously

• Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company’s business to proactively respond to changing business environment

• Advanced proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)

• 4 Year / Bachelors Degree in Business Administration, a related field, or the equivalent education and/or experience

• Minimum of zero years of leadership experience required, but two years is preferred

Tokio Marine offers a competitive salary and benefits package, including: 

• Generous paid time off (PTO), 12 paid company holidays,

• 401(k) Retirement Plan with 6% company match.

• Health and dental insurance, and vision plan available.

• Company-provided long-term disability and life insurance.

• Opportunities for advancement in a successful and growing organization.

• Flexible work schedules and a great work/life balance.

• Paid Parental Leave.

• Volunteer Time Off.

• Enjoy casual dress and work in a modern, comfortable office with free parking.

• Hybrid work schedule

The Tokio Marine HCC Group of Companies offers a successful, dynamic organization experiencing rapid growth and are seeking energetic and confident individuals to join our team of professionals. The Tokio Marine HCC Group of Companies is an equal-opportunity employer. Please visit www.tmhcc.com for more information about our companies.

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