Manager, Operational Excellence,Claims

The Manager, Claims Operational Excellence role plays a key role in the performance of the Claims Department at Gore Mutual. This role exists to lead and oversee Learning & Development, Quality Assurance Programs, Customer Experience programs, and Claims Communication. The objectives are to drive continuous improvement, ensure high-quality service delivery, and enhance customer satisfaction. The expected end results include a well-trained and efficient claims team, improved claims processes, and a superior customer experience, all contributing to the company's overall success.

What will you do?

Leading Learning & Development Initiatives

• Guiding the team in designing and implementing training programs for the claims department.
• Overseeing the assessment of training needs and development of relevant content.
• Leading the monitoring and evaluation of the effectiveness of training programs.

Overseeing Quality Assurance Programs

• Directing the team in developing and maintaining quality assurance standards.
• Ensuring adherence to regulations, privacy, and compliance standards.
• Supervising regular audits and reviews of claims processes.
• Leading the identification of areas for improvement and implementation of corrective actions.

 Enhancing Customer Experience Programs

• Steering the team in developing strategies to improve customer satisfaction.
• Overseeing the monitoring of customer feedback and identification of trends.
• Leading the implementation of initiatives to address customer concerns and improve service delivery.

Overseeing Workforce Management

• Leading and providing direction on creating and optimizing the workforce management strategy for the claims department.
• Analysing volumes, trends, forecasting and determining optimal headcount requirements for the claims department in all functions and roles.
• Oversee compliance with scheduling, phone SLAs and vacation and time off practices.
• Optimize the use of resources including flexibility of resources based on seasonality, hiring plan, need for coverage focusing on productivity and customer service excellence.
• Partner and collaborate with Operations WFM resources on enterprise-wide strategy and approach.

Managing Claims Communication

• Ensuring the team maintains clear and consistent communication within the claims department.
• Overseeing the development of communication materials and guidelines.
• Facilitating effective communication between the claims team and other departments.

Driving Continuous Improvement

Leading the team in identifying opportunities for process improvements. · Monitoring performance metrics and adjusting strategies as needed.

What will you need to succeed in this role?

• Bachelor's degree in relevant field and CIP designation desirable.
•  5-7 years of experience in the insurance industry, with a focus on claims management.
• Leadership Experience: Proven experience in leading and managing teams.
• Project Management: Experience in managing cross-functional projects and initiatives.
• Analytical Skills: Strong ability to analyze data and metrics to drive performance improvements.
• Communication Skills: Excellent verbal and written communication skills for effective interaction with internal and external stakeholders.
•  Problem-Solving Skills: Ability to identify issues and implement effective solutions.
• Technical Skills: Proficiency in using claims management software and data analytics tools.
• Customer Focus: Strong commitment to enhancing customer experience and satisfaction.
• Regulatory Knowledge: Understanding of industry regulations, privacy, and compliance standards.

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