Claims Operations Manager

This is a fully remote position, open to applicants in Florida.

📋 Description

• Supervise a claims team to achieve service targets, operational metrics, and commitments to clients.

• Facilitate collaboration among Customer Care, Administrative, and Clinical teams, as well as employees, client organizations, healthcare providers, and clinical partners for STD and FMLA absence programs.

• Ensure adherence to legal standards and confidentiality by providing timely notifications to employees and client organizations.

• Evaluate documentation that supports claim approvals and denials, and address audit inquiries.

• Serve as a Subject Matter Expert for Alight’s Leave of Absence programs.

• Offer guidance on policies, processes, and client expectations.

• Ensure precise and compliant service delivery while assisting in the resolution of complex cases.

• Lead a virtual team by establishing roles, responsibilities, and accountability measures.

• Foster talent development and enhance team capabilities to promote a high-quality culture.

• Assist clients by identifying root causes of issues and creating solutions to prevent future occurrences.

• Oversee team performance against KPIs and ensure that service and performance commitments are met.

• Manage workload distribution, performance assessments, employee development, and goal setting.

• Address client and internal inquiries in accordance with established communication standards.

• Engage in client meetings and implementation processes.

• Monitor staff adherence to schedules and communicate new or revised processes, procedures, and operational updates.

⛳️ Requirements

• A minimum of three years of leadership experience in STD/LTD product and claims management.

• Demonstrated ability to oversee daily operations and projects to meet business objectives and special assignments.

• An associate degree or equivalent professional experience.

• Exceptional communication and relationship-building skills.

• Previous supervisory experience with the capability to prioritize and delegate tasks.

• Advanced computer proficiency with Windows and Microsoft Office suite, including Word, Excel, PowerPoint, and Outlook.

• Technical expertise in utilizing technology, data, and business tools to drive innovation, enhance efficiency, support decision-making, and improve customer experience.

• Strong critical thinking skills and proven analytical business acumen.

• Creative problem-solving abilities to tackle complex business and technical challenges.

• Authorization to work in the employing country without the need for current or future visa sponsorship.

• Successful completion of relevant background checks.

🏝️ Benefits

• Health, dental, and vision coverage starting from Day One.

• Wellbeing programs.

• Retirement plans with contribution matching.

• Generous paid time off.

• Parental leave.

• Opportunities for continuing education.

• Career advancement prospects.

• Flexible working arrangements wherever feasible.

• Occasional travel to physical office locations may be required.

• Competitive total rewards package.

• Bonus and/or incentive eligibility based on role and level.

• Reasonable accommodations for individuals with disabilities and sincerely held religious beliefs, practices, and observances.