Optiom

Manager

• Oversee all claims processes from intake through resolution, ensuring efficiency, accuracy, and compliance with policies, regulations, and underwriter requirements.
• Provide technical guidance and direction to claims staff on coverage interpretation, settlement authority, and escalation handling.
• Monitor claim cycle times and SLA adherence.
• Monitor claim quality, reserve accuracy, and claim payment outcomes to minimize leakage and ensure consistency.
• Maintain strong knowledge of industry regulations and internal compliance requirements and ensure consistent adherence across the team.
• Identify and mitigate operational and compliance risks within claims handling.
• Analyze claims data and operational reports to identify trends, bottlenecks and improvement opportunities.
• Design and implement workflow enhancements and best practices that improve productivity, accuracy, speed and service quality.
• Measure and monitor post-implementation results to ensure efficiency gains are achieved and sustained.
• Use data analytics to identify patterns, forecast workload, and inform operational decisions.
• Ensure system utilization and documentation standards are consistently followed to maintain data integrity.
• Align claims operations with organizational goals on cost control, cycle time reduction, and service excellence.
• Lead, mentor, and coach the Claims team to achieve high standards of performance, accuracy, and professionalism.
• Establish clear performance expectations tied to operational, compliance and service goals.
• Conduct regular one-on-one and team meetings to review performance, address challenges, and support development.
• Promote collaboration, accountability, and continuous learning within the team.
• Ensure fair workload distribution and support staff in complex claims handling.
• Ensure all customer and partner interactions reflect professionalism, empathy, and accuracy.
• Handle escalated or complex claims or calls, balancing customer needs with compliance, cost control, and operational requirements.
• Monitor customer satisfaction metrics and feedback to identify areas for service and process improvement.

Claims Manager