Claims Case Manager
The Claims Case Manager at Delta Group plays a critical role in supporting insurance carriers, third-party administrators (TPAs), self-insured entities, and other clients in managing and resolving insurance claims efficiently, accurately, and in compliance with client and regulatory requirements. This position combines strong claims handling expertise with sound judgment to move a portfolio of claims from intake through resolution, while recognizing fraud indicators and referring suspicious or questionable claims to the Special Investigations Unit when warranted.
Responsibilities
Claims Management - Manage a portfolio of claims from intake through resolution, ensuring timely, accurate, and compliant handling. - Review claim information for coverage considerations, completeness, documentation needs, and investigative requirements. - Develop and manage claim strategies that support efficient resolution while meeting client objectives and service expectations. - Prioritize workload and monitor case progression to ensure deadlines, service levels, and client commitments are met. Investigation Coordination - Identify potential fraud indicators, claim concerns, or investigative opportunities and coordinate referrals to the Special Investigation Unit (SIU) when appropriate. - Coordinate investigative assignments with field investigators, adjusters, vendors, and internal resources. - Review investigative findings, reports, and supporting documentation to ensure accuracy, completeness, and alignment with client requirements. - Monitor investigative progress and facilitate timely resolution of outstanding issues. Client & Stakeholder Management - Serve as the primary point of contact for clients regarding claim status, investigative activities, timelines, budgets, and recommendations. - Provide timely case updates and manage client expectations throughout the claim lifecycle. - Collaborate with claims professionals, SIU personnel, investigators, vendors, and internal departments to support successful claim resolution. Documentation & Operational Excellence - Prepare claim summaries, final reports, and other client deliverables. - Maintain accurate case documentation, financial records, activity notes, deadlines, and billing information within case management systems. - Monitor case budgets and support compliance with client financial requirements. - Identify opportunities to improve workflows, service delivery, operational efficiency, and client satisfaction. - Maintain compliance