Senior Claims Manager

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

📋 Description

• Supervise a claims processing organization.

• Ensure timely processing of claims in adherence to government regulations.

• Develop policies and procedures for claims adjudication to enhance claims payment accuracy.

• Assess claims activities for cost-effectiveness and implement initiatives for process improvement.

• Oversee departmental operations, managing both individual contributors and supervisors.

• Ensure adherence to company policies, industry regulations, and service level agreements.

• Act as the lead for claim processes, regulations, and industry standard projects.

• Analyze workflow and identify necessary actions to meet current and future production and staffing requirements.

• Collaborate with cross-functional teams as a claims subject matter expert.

• Recognize trends and formulate plans to enhance results and processes.

• Research, investigate, and address escalated service issues with internal and external customers.

• Take corrective measures, including conducting root cause analysis when necessary.

• Provide sign-off approval for complex or high-value claims.

• Support the training and implementation of new processes and systems required for managing policy changes.

• Participate in or lead multiple projects by allocating resources, managing timelines, and implementing schedules.

⛳️ Requirements

• Bachelor's Degree with 4-6 years of relevant experience OR High School Diploma or GED with 6-8 years of related experience.

• Proficient knowledge of claims processing, adjudication policies and procedures, government regulations, industry regulations, and service level agreements.

• Experience in analyzing workflow and staffing requirements.

• Proven track record in identifying trends and executing process improvements.

• Background in researching, investigating, and responding to escalated service issues.

• Experience in conducting root cause analysis.

• Experience in approving complex or high-value claims.

• Familiarity with supporting training and implementing new processes and systems.

• Experience in leading or participating in multiple projects.

🏝️ Benefits

• Health, dental, and vision insurance.

• Life insurance.

• Flexible Spending Account (FSA) and Health Savings Account (HSA).

• 401(k) plan.

• Employee Assistance Program.

• Back-up care for children, adults, and elders.

• Health and wellness initiatives.

• Wellness program that enables employees to engage in health initiatives to lower insurance premiums.

• Eligibility for bonuses.