Claims Program Manager

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

📋 Description

• Proactively lead a team of Specialists managing a portfolio of claim clients, which includes Third Party Administrators and Managing General Underwriters.

• Enhance client relationships through oversight and by identifying and resolving process-related issues.

• Collaborate with Underwriting, Actuarial, Compliance, IT, and external business partners.

• Act as Audit Coordinator by scheduling, coordinating, and monitoring annual audits.

• Conduct initial reviews of necessary reports prepared by the Program Management Team members.

• Supervise Program Team member activities and support client management based on relationships.

• Serve as a liaison with administrative, operations, and underwriting departments.

• Professionally address concerns with distressed customers.

• Participate in client meetings and work to resolve outstanding issues on at least a monthly basis.

• Facilitate the resolution of technical issues in collaboration with IT.

• Assist in onboarding new clients effectively.

• Conduct due diligence and on-site evaluations of potential program administrators.

• Perform annual reviews of administrators to identify any compliance or process deficiencies.

• Monitor quarterly claims activity to detect any outliers.

• Identify issues in processing, systems, and operations that may impact claims payments.

• Prepare monthly reporting packages and analyze claims litigation, regulatory inquiries, referrals, trends, and exposures.

• Forward small claims litigation to Legal and coordinate communication with attorneys.

• Support Compliance with inquiries related to claims regulations.

• Draft, review, and update Claims Best Practices, standards, procedures, and workflows.

• Oversee the review of TPA Best Practices and ensure compliance with relevant state unfair claims practices laws.

• Cultivate Program Management Team product knowledge and enhance broader claims management skills.

• Utilize real-world situations as tools for team education and development.

• Carry out other assigned duties as necessary.

⛳️ Requirements

• Bachelor’s Degree from an accredited institution or equivalent professional experience.

• At least 6 years of relevant experience in Special Risk, Travel, and Travel Medical fields.

• Proficient in PC applications including Excel, Word, Outlook, and PowerPoint.

• Preferred experience with specialty products such as Employer Stop Loss, Travel, Short Term Medical, Medical Travel, Workers Compensation, and/or Occupational Accident.

• Willingness to travel up to 20% of the time.

• Ability to build strong relationships with both customers and team members.

• Proven track record of high service delivery centered on customer satisfaction and effective issue resolution.

• Strong analytical and problem-solving abilities.

• Exceptional attention to detail and organizational capabilities.

• Capacity to work both independently and collaboratively within a team.

• Excellent written and verbal communication skills.

• Commitment to personal accountability and continuous improvement.

🏝️ Benefits

• Competitive compensation package.

• Generous 401K employer matching.

• Employee Stock Purchase plan with employer matching.

• Generous Paid Time Off.

• Health, dental, and vision benefits.

• Family wellness programs focusing on physical, mental, and financial wellbeing.

• Tuition reimbursement opportunities.

• Support for industry-related certifications.

• Access to professional training.

• A dynamic, ambitious, fun, and exciting work environment.

• Matching donation program.

• Opportunities for volunteering.

• Employee-driven corporate giving initiatives.

• Commitment to equal employment opportunities and inclusivity initiatives.