Claims Manager

Job Summary

Managing health claims processing for self-funded employer groups, the full-time Claims Manager will oversee claim supervisors and analysts, set productivity goals, and collaborate with cross-functional teams in a remote environment.

Key responsibilities:

• Oversee the management and processing of health claims, ensuring compliance with benefit plans and service level agreements
• Directly support client relationships and issue resolution while educating and mentoring claims staff
• Develop policies and procedures for claims administration and monitor staff performance against established metrics

Required qualifications:

• At least 5 years of experience with self-funded healthcare plans in a Third Party Administrator (TPA) environment
• Proficient in MS Word, Excel, Outlook, and PowerPoint; Salesforce experience is a plus
• Strong leadership and team management skills with a focus on process development and improvement
• Understanding of health insurance benefit administration in a self-funded environment
• Experience with automated claim adjudication systems; familiarity with El Dorado-Javelina is preferred