Claims Operations Manager

Addison Group; Oklahoma City (OK); On-site; USD 85,000 - 120,000; Full time

Job summary

Addison Group in Oklahoma City is seeking an experienced Claims Operations Manager to lead the administration of supplemental life insurance claims, guiding end-to-end processes and ensuring accurate determinations with regulatory compliance.

The role demands strong leadership, extensive claims knowledge, and a commitment to compassionate service for beneficiaries, with oversight of a claims team, performance metrics, and policy development.

Qualifications

• Bachelor's degree in a related field preferred.
• Minimum of 5 years of life insurance claims experience, with at least 5 years in a supervisory or management role.
• Strong knowledge of supplemental life insurance products and claims administration.
• Thorough understanding of life insurance regulations, policy interpretation, and compliance requirements.
• Experience handling complex claims investigations and appeals.

Responsibilities

• Manage daily operations of the supplemental life insurance claims department.
• Supervise, coach, and develop a team of claims examiners and claims support staff.
• Review and approve complex or high-value life insurance claims, including AD&D claims.
• Ensure claims are processed accurately, efficiently, and in accordance with policy provisions, state regulations, and company guidelines.
• Interpret insurance contracts and determine claim eligibility based on policy terms.
• Investigate questionable or contested claims while collaborating with legal, fraud, underwriting, and compliance teams as needed.
• Monitor departmental performance metrics, productivity, quality assurance, and turnaround times.
• Identify process improvements to enhance operational efficiency and customer satisfaction.
• Resolve escalated customer concerns with professionalism, empathy, and sound judgment.
• Maintain compliance with all applicable federal and state insurance regulations.
• Prepare departmental reports and present performance metrics to senior leadership.
• Partner with underwriting, customer service, finance, and operations to improve claim outcomes and service delivery.
• Assist in developing policies, procedures, and training materials for claims staff.

Skills

Leadership

Team development

Analytical thinking

Microsoft Office

Claims management systems

Education

Bachelor's degree

Job description

A company in Oklahoma City is seeking an experienced and detail-oriented Claims Operations Manager to lead the administration of supplemental life insurance claims. This role is responsible for overseeing the end-to-end claims process, ensuring timely and accurate claim determinations, maintaining regulatory compliance, and delivering compassionate, high-quality service to beneficiaries during difficult times. The ideal candidate has strong leadership skills, extensive insurance claims knowledge, and a commitment to operational excellence.

Responsibilities

• Manage the daily operations of the supplemental life insurance claims department.
• Supervise, coach, and develop a team of claims examiners and claims support staff.
• Review and approve complex or high-value life insurance claims, including accidental death and dismemberment (AD&D) claims.
• Ensure claims are processed accurately, efficiently, and in accordance with policy provisions, state regulations, and company guidelines.
• Interpret insurance contracts and determine claim eligibility based on policy terms.
• Investigate questionable or contested claims while collaborating with legal, fraud, underwriting, and compliance teams as needed.
• Monitor departmental performance metrics, productivity, quality assurance, and turnaround times.
• Identify process improvements to enhance operational efficiency and customer satisfaction.
• Resolve escalated customer concerns with professionalism, empathy, and sound judgment.
• Maintain compliance with all applicable federal and state insurance regulations.
• Prepare departmental reports and present performance metrics to senior leadership.
• Partner with underwriting, customer service, finance, and operations to improve claim outcomes and service delivery.
• Assist in developing policies, procedures, and training materials for claims staff.

Qualifications

• Bachelor's degree in Business Administration, Insurance, Finance, Healthcare Administration, or a related field preferred.
• Minimum of 5 years of life insurance claims experience, with at least 5 years in a supervisory or management role.
• Strong knowledge of supplemental life insurance products and claims administration.
• Thorough understanding of life insurance regulations, policy interpretation, and compliance requirements.
• Experience handling complex claims investigations and appeals.
• Excellent leadership, coaching, and team development skills.
• Strong analytical, problem-solving, and decision-making abilities.
• Exceptional written and verbal communication skills.
• Proficiency with claims management systems and Microsoft Office Suite.
• Ability to manage multiple priorities in a fast-paced environment while maintaining accuracy and confidentiality.