Claims Manager

MagnaCare; Las Vegas (NV); Remote; USD 90,000 - 140,000; Full time

Job summary

MagnaCare is seeking a seasoned Claims Manager to provide strategic leadership and operational oversight of the claims department. This remote role oversees performance, quality outcomes, and customer service while coaching and developing a remote team of claims professionals.

Responsibilities include guiding partnerships with vendors and internal stakeholders, analyzing performance trends, and driving process improvements to enhance efficiency and service delivery.

Qualifications

• 5+ years of leadership experience in a claims environment.
• 5+ years of advanced healthcare claims adjudication experience.
• Experience with unionized employees and collective bargaining agreements is a plus.
• Strong written and verbal communication, interpersonal, and negotiation skills.
• Ability to analyze trends and implement effective improvements.

Responsibilities

• Lead and develop remote claims teams to high performance.
• Oversee daily claims operations, workload distribution, and quality.
• Guide collaborations with vendors and internal partners.
• Analyze performance trends and implement process improvements.
• Manage escalated issues, complex claims, and high-value adjustments.
• Coach and mentor team members to meet productivity standards.
• Conduct audits, performance reviews, and attendance management.
• Develop training programs and onboarding for new hires and vendors.
• Generate operational reports and management insights.
• Collaborate across departments to provide leadership support.

Skills

Leadership

Claims adjudication

Excel

Communication

Analytics

Time management

Education

Bachelor's degree

Job description

About The Role

The Claims Manager is responsible for providing strategic leadership and operational oversight of the claims department, with a strong focus on team performance, process efficiency, quality outcomes, and customer service excellence. This role leads, coaches, and develops claims professionals while driving continuous improvement across workflows, systems, and policies to enhance operational effectiveness and service delivery. The Claims Manager establishes performance expectations, monitors key metrics, and fosters a culture of accountability, collaboration, and professional growth. Success in this role requires strong leadership, sound decision-making, effective prioritization, and the ability to partner with cross-functional stakeholders to achieve organizational objectives. This is a remote position requiring occasional travel to Las Vegas, Nevada, as business needs dictate.

Key Responsibilities

• Lead and develop remote claims teams, promoting employee engagement and high performance.
• Manage unionized employees while ensuring compliance with collective bargaining agreements.
• Oversee daily claims operations, workload distribution, productivity, and quality performance.
• Provide guidance and support for claims, vendors, internal business partners, providers, and customers.
• Analyze performance trends and implement process improvements to increase efficiency and service quality.
• Manage escalated issues, complex claims, and high-value adjustments.
• Ensure accuracy and quality of claims processing systems, workflows, and logic enhancements.
• Coach and mentor team members to achieve and exceed productivity and quality standards.
• Conduct audits, payroll reviews, performance evaluations, and attendance management.
• Develop training programs and support onboarding for new hires and vendors.
• Generate operational reports, audit summaries, and management insights.
• Collaborate across all departments and provide leadership support where needed.

Essential Qualifications

• 5+ years of leadership experience, preferably within a claim’s environment, with a proven ability to lead, coach, and develop high-performing teams.
• Advanced proficiency in Microsoft Office, including strong working knowledge of Word and Excel.
• 5+ years of advanced healthcare claims adjudication experience, including facility, professional, and ancillary claims.
• Excellent written and verbal communication, interpersonal, and negotiation skills, with the ability to effectively manage priorities in a fast-paced environment.
• Strong analytical and problem-solving skills with the ability to identify issues, evaluate options, and implement effective solutions.
• Demonstrated organizational and time-management skills, with the ability to prioritize multiple responsibilities and meet deadlines.
• Ability to build and maintain positive, productive relationships with clients, providers, members, customers, vendors, and internal stakeholders.
• Positive, adaptable, and collaborative leadership style with the flexibility to thrive in a dynamic and evolving environment.
• Bachelor's degree preferred; equivalent healthcare claims or operations experience will be considered.
• Bilingual skills preferred.

At MagnaCare LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

For more than 30 years, MagnaCare LLC has been a trusted partner in delivering flexible, customized solutions for self-insured organizations. As a national third-party administrator (TPA), we combine proprietary technology, network expertise, and a deep understanding of labor to help our clients achieve their goals while supporting the people they serve.

Our focus on labor means we work closely with funds, Taft-Hartley Trusts, and other self-insured groups to deliver tailored solutions that go beyond the basics. From health plan administration and eligibility management to contribution accounting, we provide the tools and support organizations need to succeed.

With specialized offerings such as flexible network administration, direct contracting, in-house medical and care management, and workers’ compensation programs, we create benefit plans that address unique needs with precision.