Claims Manager - Remote

Overview

The Claims Manager provides coaching, mentoring and training of Claims Examiners while promoting quality results. The manager is responsible for identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team. Provides on-going feedback to the team and identifies areas for improvement and growth. Must be able to make independent decisions, prioritize workload effectively and collaborate with other internal departments to assist in meeting our corporate goals.

In Short

• Effectively manage remote teams, promoting strong leadership and employee engagement.
• Provide comprehensive support for claims, appeals, internal departments, vendors, and customers.
• Daily workload distribution and monitoring for timely resolution.
• Conduct training for new hires, vendors, and existing staff.
• Handle escalated issues and process high-value claims and adjustments.
• Identify process improvement opportunities and establish supporting workflows.
• Review and ensure quality of claims and logic changes in Impact.
• Support Customer Service, Client Services, and respond to inquiries.
• Coach employees to exceed quality and productivity standards, addressing performance issues.
• Conduct audits and manage payroll, schedules, and time off requests.

Requirements

• 5+ years in a leadership role—preferably claims.
• Advanced knowledge of Microsoft Word and Excel.
• 5+ years of advanced claims adjudication experience including facility, professional and ancillary claims.
• Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required.
• Strong problem solving/analysis skills.
• Organizational skills; ability to effectively prioritize and multitask.
• Ability to establish and maintain positive and effective work relationships with clients, coworkers, members, providers and customers.
• Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
• Bachelor’s Degree preferred or comparable experience in the healthcare field.

Benefits

• Encouraging and respectful workplace culture.
• Diversity and inclusion initiatives.
• Opportunity to impact healthcare delivery.
• Flexible and cutting-edge third-party administration services.
• Comprehensive training and support.