Claims Support and Process Senior Consultant for Casualty Claims PIP / Med Pay Operations
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Allstate embraces creative problem solving and innovative thinking – especially when it comes to designing the right business processes and technology solutions. All of our employees are challenged to maximize their own focus, resourcefulness and diversity… (And we take work-life balance and personal/professional development very seriously). That's why we're looking for an independent, highly motivated and creative individual to help us differentiate the way we design and deliver solutions that provide the best value to our customers, employees and Company.
The Home Office Line Management team is responsible for partnering with and advising the Enterprise operations on a variety of business and operational functions including product support, vendor management, and project support. The Process Design function develops or modifies products or processes based on market research, requests from the AORs, customer experience analysis, or other data and supports the Field in responding to issues and questions.
We're looking for a highly motivated Claims Support & Process Sr. Consultant who can apply their expertise in Healthcare Management or related field through industry knowledge, analysis, attention to detail, innovative thinking, organizational, communication and project management skills to help deliver quality solutions for the PIP / Med Pay Line Management Team.
This job is responsible for applying intermediate knowledge of PIP/ Med Pay claim handling processes, coding of medical bills, analyzing, developing, and delivering innovative medical claim handling processes based on various drivers including regulatory changes, quality trends, customer service trends, and severity and expense management trends. The role analyzes data, identifies process, technology, and execution gaps, and presents results to leaders, recommending process changes to improve business results in partnership with other stakeholders. The job coordinates, prioritizes, and manages process and technology projects. The individual works independently, prioritizes the individual's own responsibilities, and manages the individual's own workload. The individual consistently meets band level behaviors, production, and quality and/or customer service goals.
Process Design / Improvement
- Manages and conducts research of impact of industry and regulatory changes and/or current state Field processes, including Field visits, feedback sessions, and industry/competitive intelligence, to identify process gaps
- Develops recommendations to address identified process gaps and designs process enhancements and/or new processes to address the issues and achieve desired business outcomes
- Develops timelines, coordinates resources, and establishes check-in meetings to implement process enhancements and/or new processes
- Engaged in process improvement implementation and communicates status to all stakeholders
- Leads or acts as individual contributor to projects and manages team members and holds them accountable
- Develops quality assurance processes and guidelines for various Field roles and vendors, which may include quality review forms, quality reporting, technical platform support, and audit standards
- Provides trend and results analysis on quality assurance to leadership
- Researches and responds, or reviews the research of others to respond, to Field inquiries made on a variety of questions, concerns, and topics
- Shares subject matter expertise on a variety of subjects with Field and other Home Office partners on a daily basis
- Collaborates with Home Office and cross functional groups on various projects and product changes involving the disciplines the role supports
- Communicates changes in process and develops and provides vendor performance data
- Oversees and coordinates the development of periodic training sessions and communication updates to the Field, including, but not limited to, job aids, home page alerts, claims and policy handling guidelines, script changes, process communications, and leader communications, including Field and Home Office directors and officers; may also facilitate training sessions
- Bachelor's degree in Health Information Management or related field
- Experience in medical claims handling preferred, including coverage, medical treatment protocols, billing, pricing and management. Certified Medical Bill Coder a plus.
- Applies highly advanced knowledge of insurance policy, coverage, and regulation
- Applies highly advanced knowledge of claim processes, policies, procedures, claim systems, coverage, liability, and/or settlement, and adherence to applicable legal compliance standards
- Applies highly advanced industry knowledge of first party medical claim handling practices, including best practices, to support the business unit
- Applies knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data
- Applies highly advanced ability to leverage learned technical skills in support of team objectives
- Applies highly advanced problem solving skills to continuously improve business outcomes
- Ability to assist leadership in achieving business unit objectives
- Applies highly advanced knowledge of training facilitation and coaching skills
- Ability to investigate, evaluate and settle highly complex claims
- Provides highly advanced individual decision making within authority limits
- Works within highly complex assignments requiring specialized knowledge in breadth and/or depth in area of expertise
- 30 to 40% travel
The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.
Good Work. Good Life. Good Hands®.
As a Fortune 100 company and industry leader, we provide a competitive salary – but that's just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, you'll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy.
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Allstate generally does not sponsor individuals for employment-based visas for this position.
Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.
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