• Customer interaction and effective communications are vital aspects of this role.
• The Claims Manager works to improve processes and maintain compliance with industry standards.
• Manage daily operations of the claims department.
• Self-Funded or Fully Insured Health Plan experience required.
• Health or Medical Insurance background required.
• Ensure all claims are reviewed, processed, and settled in a timely manner.
• Develop, implement, and enforce claim policies and procedures.
• Establish and maintain effective relationships with customers, vendors, and other stakeholders.
• Monitor and evaluate claims activity to ensure accuracy and compliance with laws and regulations.
• Resolve complex claims issues and disputes.
• Train, mentor, and lead claim staff as needed.
• Provide periodic reports to senior management.
• 5+ years of experience in claims management preferred.
• Knowledge of insurance regulations and industry best practices.
• Well-developed oral and written communication skills to meet a variety of communication needs.
• Good interpersonal skills that foster open upward and downward communication built on mutual respect.
• Ability to work independently and manage multiple tasks.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Bachelor’s degree from four-year college or university in a related field, or equivalent; and four-six (4-6) years minimum related experience and/or training; or equivalent combination of education and experience.

Ability to define problems, collect data, establish facts, and draw valid conclusions when processing claims.

• Proficiency in Microsoft Applications (Word, Excel).
• Ability to remain calm when faced with mounting pressure related to deadlines and multiple priorities.
• Exceptional ability to work on a team, and resolve conflict when needed.
• Ability to interface with clients, win new work, and determine their requirements.
• Organization, critical thinking, problem-solving skills, decision making, and adaptability.