Claims Processing Manager: Lead Client Relations & Ops

Florida Blue; Irving (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Florida Blue is seeking a Manager of Claims Processing to lead the claims operations, focusing on reviewing procedures for new clients, Summary Plan Documents, and clarifying plan benefits. The role requires directing teams, coaching staff, and partnering with HR to drive performance.

You will manage Claims Assistant Managers, hire and promote from within WebTPA, conduct 1:1 updates and appraisals, resolve issues with providers and plans, maintain client relationships through weekly calls and

Qualifications

• 4+ years related work experience in the claims administrative industry.
• 2+ years direct supervisory/management experience.
• Related Bachelor’s degree or additional related equivalent work experience.
• Strong verbal and written presentation/communication skills.
• Ability to handle confidential and sensitive information appropriately.
• Comfortable working across operational departments and with clients.
• Microsoft Office skills: Word, Excel, and Outlook.
• Experience with CPT coding and related procedural reviews is a plus.
• Strong time and project management skills.

Responsibilities

• Oversee supervisors and managers of claims processing teams.
• Hire and promote from within WebTPA.
• Provide direction and coaching on performance of AMCS and teams.
• Conduct 1:1 meetings for updates and performance appraisals.
• Issue disciplinary measures in partnership with HR.
• Manage client relationships as primary contact for daily items and updates.
• Resolve claims issues by researching plan coverage and history.
• Report updates to Sr. Manager Ops and Director Ops.
• Partner with plan sponsors, members, and coworkers to meet customer expectations.
• Direct contact with providers to resolve contract and payment issues.
• Monitor Client Performance Guarantees and performance metrics.
• Advise on improvements and training needs based on metrics and feedback.
• Collaborate with HR Talent Development on training initiatives.

Skills

Verbal communication

Written communication

Leadership

Time management

Project management

Performance coaching

Education

Bachelor's degree or equivalent

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Florida Blue is seeking a Manager of Claims Processing to lead the claims operations, focusing on reviewing procedures for new clients, Summary Plan Documents, and clarifying plan benefits. The role requires directing teams, coaching staff, and partnering with HR to drive performance.

You will manage Claims Assistant Managers, hire and promote from within WebTPA, conduct 1:1 updates and appraisals, resolve issues with providers and plans, maintain client relationships through weekly calls and