Manager, Claims

Integrity Marketing Group•Clearwater, FL

12d

About The Position

The Claims Department Manager leads the day-to-day performance and administration of claims department operations. The role oversees claims supervisors, support functions, and operational initiatives to ensure claims are processed accurately, promptly, and in compliance with client, regulatory, financial, and customer service expectations. Working with the Director of Claims and other organizational leaders, the manager identifies business needs, implements operational improvements, supports strategic initiatives, and advances process efficiency. The role is accountable for departmental performance, staff development, quality outcomes, inventory management, and effective use of claims administration systems and supporting technologies. The position may require occasional travel for training, meetings, or business-related activities. Work may be performed in a standard office or remote work environment, as applicable.

Requirements

Minimum five years of proven experience in the health insurance industry, with progressive responsibility in health claims operations.
Demonstrated leadership experience managing supervisors and multiple operational teams.
Proficiency with Microsoft Office applications, including Word and Excel.
Ability to interpret policy provisions, benefits, eligibility requirements, and claims payment methodologies.
Strong analytical, problem-solving, and decision-making skills.
Excellent verbal, written, and interpersonal communication skills.
Ability to manage competing priorities and meet deadlines in a fast-paced environment.
Ability to maintain a dependable work schedule and meet attendance expectations.
Ability to exercise sound judgment while maintaining confidentiality and professionalism.
Bachelor’s degree in Healthcare Administration, Business Administration, Insurance, or a related field is preferred; equivalent education and relevant experience may be considered.

Nice To Haves

Familiarity with medical terminology, procedure codes, diagnosis codes, and healthcare claims processing practices.
Experience with claims administration systems, workflow management tools, and related operational technologies.
Bachelor’s degree in Healthcare Administration, Business Administration, Insurance, or a related field.

Responsibilities

Participate in operational planning, workforce planning, and resource allocation to support Claims Department objectives.
Oversee the preparation, analysis, and distribution of operational, client, regulatory, and management reports.
Monitor claim payment accuracy, quality, productivity, inventory levels, turnaround times, and service-level performance; develop and implement corrective action plans when standards are not met.
Ensure department policies, procedures, workflows, and operational controls are consistently applied, maintained, and updated in a timely manner.
Maintain understanding of company policies, organizational objectives, and operational processes affecting claims operations and employee performance.
Plan, direct, coordinate, and evaluate department workflows, operational priorities, and special projects assigned by leadership.
Train, coach, mentor, and evaluate direct reports, supporting employee development, accountability, and engagement.
Lead and participate in user acceptance testing, implementation activities, and operational readiness reviews for claims-related projects, system enhancements, and process changes.
Partner with the Director of Claims and Human Resources on hiring, employee development, performance management, disciplinary actions, promotions, and succession planning.
Support strategic initiatives, including system implementations, client conversions, operational improvements, regulatory requirements, and client-driven projects.
Oversee departmental initiatives and ensure timely completion of assigned goals, projects, and deliverables.
Maintain working knowledge of the claims administration system, workflows, interfaces, system integrations, and operational dependencies affecting claims processing.
Collaborate with internal business partners, vendors, clients, and technology teams to identify, define, validate, and implement business and operational requirements.
Build and maintain effective working relationships with department managers, supervisors, team leads, claim support staff, and employees across the organization.
Perform other duties as assigned.