Claims Manager

Job Summary

A company is looking for a Claims Manager - Management Ancillary Support (CMAS).

Key Responsibilities

• Ensure accurate processing of claims, appeals, and adjustments in compliance with regulations and benefit plans
• Oversee claim inventory management and set team priorities to meet service-level agreements
• Develop and monitor operational and quality KPIs, driving process improvements and team performance

Required Qualifications

• Bachelor's degree or equivalent work experience
• 5+ years of experience in healthcare claims administration, preferably in self-funded or TPA environments
• Experience managing teams involved in claims audit, appeals, recovery, and quality
• Strong understanding of benefit administration and regulatory requirements
• Prior experience with automated claims adjudication systems