Provide an environment that allows staff members to flourish in their work duties. Quality levels of 99% maintained throughout the department. Continuous training of staff on all enhancements and updates to claims regulations and company policies. Develop procedure changes to improve results. Corrective action plans developed and implemented to remediate.
Maintain quality goals and production levels within the Department. Working with department supervisors, ensures that production goals associated with each work area are consistently met and that supervisors receive mentoring as appropriate to ensure department goals are met.
Create, maintain and monitor departmental documents including policies, procedures, desktop procedures, workflow documents and job aids to ensure these documents are current and meet the requirements of L.A. Care. Claims examiners and auditors are utilizing authorized procedures that are well documented and meet the business needs of L.A. Care. All procedures meet applicable regulatory requirements.
Ability to track and trend the metrics associated with the examiner and auditor production and prepare and present written and verbal reports. Ability to research complex problem areas within the department or within the systems used by department, identify the root cause of these issues and recommend corrective actions. Continuous monitoring of work performed within the claims department. The Manager must have the ability to research problems of a complex nature and create clear and concise documentation. The Manager must work collaboratively with peers throughout the company to achieve the goals of the company. The Manager must provide mentoring to supervisors and Claims department staff ensuring that they are working effectively and meeting quality and production goals. Use data analysis and independent judgment to improve processes within the department.
Provide an environment that engages staff to fully participate in the overall functioning of the unit. The Department flourishes under the leadership of the Manager producing high quality work in a high production environment.
Develop goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.
Perform other duties as assigned.