Manager, Claims

Integrity • Clearwater, FL

13d

About The Position

The Claims Department Manager leads the day-to-day performance and administration of claims 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. The manager partners with the Director of Claims and other organizational leaders to identify business needs, implement improvements, support strategic initiatives, and increase process efficiency. The position is accountable for departmental performance, employee development, quality outcomes, inventory management, and effective use of claims administration systems and supporting technologies.

The role requires leadership across operational planning, staffing and resource allocation, reporting, quality and productivity monitoring, workflow management, and project delivery. The manager also supports hiring and employee management, system and process changes, client and regulatory initiatives, and collaboration with internal and external partners. Work may be performed in a standard office or remote environment, as applicable, and occasional travel may be required.

Requirements

• At least five years of 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.
• Ability to perform work in a standard office or remote work environment, as applicable.

Nice To Haves

• Bachelor’s degree in Healthcare Administration, Business Administration, Insurance, or a related field; equivalent education and relevant experience may be considered.
• 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.
• Occasional travel may be required for training, meetings, or business-related activities.

Responsibilities

• Participate in operational planning, workforce planning, and resource allocation to support Claims Department objectives.
• Oversee preparation, analysis, and distribution of operational, client, regulatory, and management reports.
• Monitor claim payment accuracy, quality, productivity, inventory, turnaround times, and service-level performance; implement corrective action plans when standards are not met.
• Ensure department policies, procedures, workflows, and operational controls are consistently applied, maintained, and updated.
• Maintain knowledge of company policies, organizational objectives, and operational processes that affect 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 to foster development, accountability, and engagement.
• Lead and participate in user acceptance testing, implementation activities, and operational readiness reviews for claims 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, 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 other employees.

Benefits

• Competitive compensation package, including benefits intended to provide employees and their families with peace of mind.
• Professional opportunities to accelerate career development.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager