Claims Administration Manager

RiseMe; Frisco (TX); On-site; USD 55,000 - 75,000; Full time

Job summary

Careington International in Frisco, TX is seeking a Claims Specialist to manage workloads, update incidents, and oversee end-to-end claims operations.

You will interact with external customers and vendors, escalate risks, and collaborate with leadership to align goals while ensuring compliance with policies and regulations. Candidates should have a Bachelor's degree in Business or related field and 3+ years of claims experience, with strong communication and organizational skills.

Qualifications

• Bachelor’s degree in Business or a related field.
• 3+ years of relevant experience in Claims or related field.
• Familiarity with Microsoft Office.
• Preferred: experience in a highly regulated field such as insurance or finance.

Responsibilities

• Manage the workload of the Claims Specialist.
• Continuously manage and update existing incidents and claims in the Careington database.
• Interact with external customers and vendors.
• Apprise management of escalated risk.
• Develop a strong team through training and effective organizational development practices.
• Manage and oversee end-to-end claims administration operations including escalation management.
• Act as an escalation point for complex or sensitive claims or customer issues.
• Ensure claims are handled accurately, efficiently, and in compliance with internal policies and applicable regulations.
• Partner with Claims leadership to align departmental goals, staffing models, and operational priorities.
• Collaborate cross-functionally with other departments such as the contact center to resolve issues and improve processes.
• Ensure all claim submissions meet quality control standards and internal documentation policies.

Skills

Independent work

Organization & PM

Communication skills

Customer service orientation

Attention to detail

Education

Bachelor’s degree in Business or related field

Tools

Microsoft Office

Job description

For more than 45 years, Careington International has been a leader in the health and wellness benefits space. Since its founding in 1979, Careington has been delivering dental discount solutions as its core competency. Today, Careington has expanded to offer a growing portfolio of 150+ health, wellness, lifestyle and virtual health products and services designed to deliver cost savings across a spectrum of life needs. Through its affiliated nationally licensed third-party administrator (TPA), Careington also delivers full-scale administrative services, including customer service, licensed enrollment, claims administration, individual and group billing.

This role will be worked in office 5x a week in Frisco, TX at our corporate office.

Roles and Responsibilities:

• Manage the workload of the Claims Specialist.
• Continuously manage and update existing incidents and claims in the Careington database.
• Interact with external customers and vendors.
• Apprise management of escalated risk.
• Develop a strong team through training and effective organizational development practices.
• Manage and oversee end-to-end claims administration operations including escalation management.
• Act as an escalation point for complex or sensitive claims or customer issues.
• Ensure claims are handled accurately, efficiently, and in compliance with internal policies and applicable regulations.
• Partner with Claims leadership to align departmental goals, staffing models, and operational priorities.
• Collaborate cross-functionally with other departments such as the contact center to resolve issues and improve processes.
• Ensure all claim submissions meet quality control standards and internal documentation policies.

Qualifications and Skills:

Required

• Bachelor’s degree in Business or a related field.
• 3+ Years of relevant experience in Claims or a related field.
• Familiarity with Microsoft Office.

Preferred

• Prior experience in a highly regulated field such as insurance or finance.

Skills:

• Ability to work independently with a high level of accuracy.
• Strong organizational and project management skills.
• Excellent written and oral communication skills.
• Strong customer service orientation.
• High attention to detail and commitment to accuracy.