AVP, Claim Manager

JOB DESCRIPTION

The Brandywine Assistant Vice President- Claim Audit Manager is responsible for the management of the claim audit staff.

The manager oversees the claim audit process to ensure compliance with industry regulations, company policies, and best practices.

This role involves analyzing claims data, leading audit processes, managing a team of auditors, and implementing improvements to enhance operational efficiencies.

JOB RESPONSIBILITIES

Staff Management


* Regular review of the work of the audit team and the Medicare reporting process.


* Set objectives for claim professionals and track progress throughout the year.

Provide positive and constructive feedback and strive to identify growth opportunities.


* Clearly communicate company's policies, requirements, and expectations.

Identify and address performance issues.

Conduct quarterly and year-end performance reviews.


* Foster a positive work environment.

Core Responsibilities:


* Oversee the claim audit process to conclusion.


* Provide critical support for annual reserve review process, including the collection of claim data and accuracy of data.


* Track detailed summary of claim file audit results for each account audited.


* Analyze audit results and prepare detailed reports highlighting findings, trends, and recommendations for improvements.


* Collaborate with claims management to address audit findings and implement corrective actions.


* Train and mentor audit team members, providing guidance on audit processes and best practices.


* Assist in the development and maintenance of audit tools and methodologies to streamline processes and increase efficiency.


* Serve as the principal liaison with Chubb Internal Audit regarding the Brandywine Claim File Audit process and results and respond to requests for supporting documentation and other information.


* Oversite of external and internal legal bill audit resources.

Assist staff with audit results.

Report key outcomes to senior management.


* Oversite of the Brandywine Medicare Reporting Process.


* Provide support to Brandywine Reinsurance, including supplying claim and financial information to facilitate reinsurance collection and managing the flow of information between the Reinsurance Group and Claim Professionals.


* Oversite of the new claim intake process.


* Manage Brandywine Direct Claims usage of outside consultants for claim file audit support.


* Coordinate the collection of claim data utilizing Brandywine tools and provide related training.


* Conduct quality control review of account summaries.

QUALIFICATIONS



* A minimum of 10 years of experience in claims auditing or related field within the insurance industry.


* 4-year college degree.

DESIRED QUALIFICATIONS


* Strong knowledge of claims processes, insurance regulations, and auditing standards.


* Proven experience in managing teams and leading audit initiatives....