Manager, Claims Operations

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

📋 Description

• Oversee the daily operations of the Claims Appeals, Claims Medical Review, and Subrogation Teams

• Track team performance metrics and operational efficiency

• Apply best practices aligned with company objectives

• Recognize strategic opportunities through financial assessments, projections, and cost/benefit analysis

• Offer support, direction, leadership, and motivation to team members

• Generate reports and analyses adhering to established standards and protocols

• Provide technical expertise on claim investigations, reserving evaluations, and claim resolutions

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

• Review high-value appeals, medical review referrals, and subrogation cases

• Manage claims production operations and engage with all parties involved in claims

• Work alongside Claims and business leaders on enterprise-wide initiatives

• Prepare documentation for subrogation cases

• Supervise both individual and team performance against productivity and quality benchmarks

• Lead, coach, inspire, and develop team members

• Conduct individual meetings and performance evaluations

• Provide training, resources, expectations, and constructive feedback on performance

• Attract and cultivate new talent

• Undertake additional responsibilities as assigned

⛳️ Requirements

• Bachelor’s degree or equivalent professional experience is mandatory

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

• At least 3 years of experience in a supervisory capacity

• Proven leadership competencies

• Comprehensive understanding of Claims, Benefits, and administrative skills and processes

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

• Capability to quickly learn new software and systems

• Proficient in writing business correspondence and procedural documentation

• Internet service with a cable broadband or fiber optic provider, offering at least 100 Mbps download and 25 Mbps upload speeds

• Ability to engage in prolonged periods of sitting and computer work

🏝️ Benefits

• Medical Insurance

• Dental Insurance

• Vision Insurance

• Life Insurance

• Disability Insurance

• Generous Paid Time Off

• Tuition Reimbursement

• Employee Assistance Program (EAP)

• Technology Stipend

• Flexible remote work from home options