Manager, Claims Operations

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

📋 Description

• Oversee the daily operational activities of the Claims Appeals, Claims Medical Review, and Subrogation Teams.

• Track and assess metrics and operations within these teams.

• Apply best practices in alignment with company objectives.

• Discover strategic opportunities through financial assessment, forecasts, and cost/benefit evaluations.

• Offer support, guidance, leadership, and motivation to team members.

• Prepare reports and analyses that adhere to established standards and processes.

• Provide technical advice on claim investigations, reserving assessments, and claim resolutions.

• Collaborate with the analytical team to generate results and trend reports for leadership review.

• Review significant appeals, medical review referrals, and subrogation cases.

• Manage daily claims production operations.

• Engage with all parties involved in the claims process.

• Work in partnership with Claims and business leaders on enterprise-wide initiatives.

• Assist with or prepare files related to subrogation.

• Supervise individual and unit performance in relation to productivity and quality targets and metrics.

• Lead, mentor, motivate, and develop team members.

• Conduct individual meetings and performance reviews.

• Provide training, resources, expectations, coaching, counseling, and timely constructive feedback.

• Carry out additional duties as assigned.

⛳️ Requirements

• A Bachelor’s degree or equivalent professional experience is required.

• Minimum of 5 years of experience in TPA or group health insurance.

• At least 3 years of experience in a supervisory role.

• Proven leadership skills and competencies.

• Comprehensive knowledge of Claims, Benefits, and administrative skills and processes.

• Intermediate proficiency in Microsoft Office, including Word, Excel, Access, and PowerPoint.

• Capability to quickly adapt to new software and systems.

• Proficient in writing business correspondence and procedures.

• A reliable internet connection via cable broadband or fiber optic service provider.

• Internet speeds of no less than 100Mbps download and 25Mbps upload.

🏝️ Benefits

• Medical Insurance

• Dental Insurance

• Vision Insurance

• Life Insurance

• Disability Insurance

• Generous Paid Time Off

• Tuition Reimbursement

• Employee Assistance Program (EAP)

• Technology Stipend

• Fully remote work

• Flexible work-from-home arrangement