Claims Manager

Brighton Health Plan Solutions; Village of Westbury (NY); Hybrid; USD 85,000 - 95,000; Full time

Job summary

An established industry player is seeking a Claims Manager to lead a dynamic team in enhancing workflow efficiency and productivity. This role requires a strong leader with over 5 years of experience in claims management, adept in coaching and mentoring. The ideal candidate will thrive in a hybrid environment, collaborating across departments to drive quality results. Join a diverse and inclusive workplace that values your unique contributions and fosters a sense of belonging. If you are passionate about transforming healthcare delivery and improving team performance, this opportunity is perfect for you.

Qualifications

• 5+ years in a leadership role, preferably in claims management.
• Advanced knowledge of Microsoft Office tools, especially Excel.

Responsibilities

• Manage remote teams, ensuring strong leadership and engagement.
• Identify process improvements and conduct training for staff.

Skills

Leadership

Claims Adjudication

Communication Skills

Problem Solving

Organizational Skills

Interpersonal Skills

Education

Bachelor’s Degree in Healthcare or Related Field

Tools

Microsoft Word

Microsoft Excel

Job description

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Brighton Health Plan Solutions provided pay range

This range is provided by Brighton Health Plan Solutions. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$85,000.00/yr - $95,000.00/yr

Claims Manager

Brighton Health Plan Solutions

Westbury, NY

Hybrid

Full Time

About The Role

The Claims Manager provides coaching, mentoring and training of Claims Examiners while promoting quality results. The manager is responsible for identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team. Provides on-going feedback to the team and identifies areas for improvement and growth. Must be able to make independent decisions, prioritize workload effectively and collaborate with other internal departments to assist in meeting our corporate goals.

Primary Responsibilities

• Effectively manage remote teams, promoting strong leadership and employee engagement.
• Provide comprehensive support for claims, appeals, internal departments, vendors, and customers.
• Daily workload distribution and monitoring for timely resolution.
• Conduct training for new hires, vendors, and existing staff.
• Handle escalated issues and process high-value claims and adjustments.
• Identify process improvement opportunities and establish supporting workflows.
• Review and ensure quality of claims and logic changes in Impact.
• Support Customer Service, Client Services, and respond to inquiries.
• Coach employees to exceed quality and productivity standards, addressing performance issues.
• Conduct audits and manage payroll, schedules, and time off requests.
• Document and address performance concerns, conducting quarterly evaluations.
• Regularly conduct individual and team meetings.

Essential Qualifications

• 5+ years in a leadership role—preferably claims
• Advanced knowledge of Microsoft Word and Excel.
• 5+ years of advanced claims adjudication experience including facility, professional and ancillary claims.
• Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required.
• Strong problem solving/analysis skills.
• Organizational skills; ability to effectively prioritize and multitask.
• Ability to establish and maintain positive and effective work relationships with clients, coworkers, members, providers and customers.
• Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
• Bachelor’s Degree preferred or comparable experience in the healthcare field.

About Brighton Health Plan Solutions

At Brighton Health Plan Solutions, 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 your unique abilities.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

*We are an Equal Opportunity Employer

Annual Salary Range: $85,000 - $95,000

The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.

Seniority level

Mid-Senior level

Employment type

Full-time

Job function

Customer Service and Management

Industries

Insurance, Medical Practices, and Hospitals and Health Care