Claims Operations Manager – Leave Solutions

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

📋 Description

• Supervise a claims team to ensure that service objectives, operational metrics, and client commitments are fulfilled.

• Align corporate goals with client expectations and team performance to meet productivity, SLA, quality, and customer satisfaction standards.

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

• Ensure legal compliance and maintain confidentiality by providing timely notifications to employees and client organizations.

• Review documentation that supports claim approvals and denials, and address audit requests.

• Act as a Subject Matter Expert for Alight Leave of Absence programs, providing guidance on policies, processes, and client requirements.

• Lead a virtual team by defining roles and responsibilities, establishing accountability, and enhancing talent and people capabilities.

• Assist clients in diagnosing root causes of issues, developing solutions, and recommending preventive measures.

• Manage team performance in relation to KPIs and service and performance guarantees.

• Oversee workload distribution, performance management, employee development, and goal-setting initiatives.

• Address client and internal inquiries while participating in client meetings and implementations.

• Monitor staff schedule adherence and communicate any process, procedure, and operational changes.

⛳️ Requirements

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

• Demonstrated ability to manage 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 using Windows and Microsoft Office, including Word, Excel, PowerPoint, and Outlook.

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

• Strong critical thinking skills with proven analytical acumen.

• Innovative problem-solving abilities to tackle complex business and technical issues.

• Work authorization in the employing country without the need for current or future visa sponsorship.

• Successful completion of a background check, if applicable.

🏝️ Benefits

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

• Wellbeing programs.

• Retirement plans with contribution matching.

• Generous time off.

• Parental leave.

• Opportunities for continuing education.

• Career advancement prospects.

• Flexible working arrangements wherever feasible.

• Occasional travel to physical office locations may be necessary.