Claims Manager

MagnaCare•Las Vegas, NV

5d•Remote

About The Position

The Claims Manager provides strategic leadership and operational oversight of the claims department, focusing on team performance, process efficiency, quality outcomes, and customer service. The role leads, coaches, and develops claims professionals and drives continuous improvement across workflows, systems, and policies. The Claims Manager sets performance expectations, monitors key metrics, and fosters accountability, collaboration, and professional growth. This remote position requires occasional travel to Las Vegas, Nevada, as business needs dictate.

Requirements

At least 5 years of leadership experience, preferably in a claims environment, with a demonstrated ability to lead, coach, and develop high-performing teams.
At least 5 years of advanced healthcare claims adjudication experience, including facility, professional, and ancillary claims.
Advanced proficiency in Microsoft Office, including strong working knowledge of Word and Excel.
Excellent written and verbal communication, interpersonal, and negotiation skills, including the ability to manage priorities in a fast-paced environment.
Strong analytical and problem-solving skills, including the ability to identify issues, evaluate options, and implement solutions.
Strong organizational and time-management skills, including the ability to prioritize multiple responsibilities and meet deadlines.
Ability to build and maintain positive, productive relationships with clients, providers, members, customers, vendors, and internal stakeholders.
Positive, adaptable, and collaborative leadership style, with flexibility to thrive in a dynamic and evolving environment.

Nice To Haves

Bachelor's degree preferred; equivalent healthcare claims or operations experience will be considered.
Bilingual skills preferred.

Responsibilities

Lead and develop remote claims teams, promoting employee engagement and high performance.
Manage unionized employees while ensuring compliance with collective bargaining agreements.
Oversee daily claims operations, workload distribution, productivity, and quality performance.
Provide guidance and support to claims teams, vendors, internal business partners, providers, and customers.
Analyze performance trends and implement process improvements to increase efficiency and service quality.
Manage escalated issues, complex claims, and high-value adjustments.
Ensure accuracy and quality of claims processing systems, workflows, and logic enhancements.
Coach and mentor team members to achieve and exceed productivity and quality standards.
Conduct audits, payroll reviews, performance evaluations, and attendance management.
Develop training programs and support onboarding for new hires and vendors.
Generate operational reports, audit summaries, and management insights.
Collaborate across departments and provide leadership support where needed.