Design Lead Consultant - 1st Party Casualty Operations

Description :

Where good people build rewarding careers.

Think that working in the insurance field can’t be exciting, rewarding and challenging? Think again. You’ll help us reinvent protection and retirement to improve customers’ lives. We’ll help you make an impact with our training and mentoring offerings. Here, you’ll have the opportunity to expand and apply your skills in ways you never thought possible. And you’ll have fun doing it. Join a company of individuals with hopes, plans and passions, all using and developing our talents for good, at work and in life.

Job Description

The Role

We’re looking for a highly motivated Claims Support & Process Lead 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 Claims 1st Party Line Management Team.

The Team

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.

Role Responsibilities

This job is responsible for 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.

Job Qualifications

  • 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

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.

For jobs in San Francisco, please see the notice regarding the San Francisco Fair Chance Ordinance.

It is the policy of Allstate to employ the best qualified individuals available for all jobs without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity/gender expression, disability, and citizenship status as a veteran with a disability or veteran of the Vietnam Era.

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