Manager, Claims Operations

Allied Benefit Systems; United States; Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Remote work

Generous PTO

Tuition reimbursement

Employee assistance program (EAP)

Technology stipend

Job summary

Allied Benefit Systems is seeking a Manager, Claims Operations to oversee the Claims Appeals, Medical Review, and Subrogation teams in a remote setting. You will drive day-to-day operations, monitor metrics, and align processes with company goals.

The role requires 5+ years in TPA or group health insurance with supervisory experience, strong leadership, and proficiency in MS Office. You will coach staff, report on performance, and collaborate with cross-functional leaders to optimize claims

Qualifications

• 5+ years of TPA or group health insurance experience including supervisory roles.
• Strong knowledge of claims processes, benefits, and administration.
• Proficient with Microsoft Office (Word, Excel, Access, PowerPoint).

Responsibilities

• Oversee day-to-day operations of Claims Appeals, Medical Review, and Subrogation teams.
• Monitor productivity and quality metrics; drive process improvements.
• Provide leadership, coaching, and performance feedback to staff.

Skills

Team leadership

Operations management

Analytical skills

Communication

Microsoft Office

Education

Bachelor's degree or equivalent

Job description

POSITION SUMMARYThe Manager, Claims Operations is responsible for managing the day-to-day operational functions of the Claims Appeals, Claims Medical Review, and Subrogation Teams.ESSENTIAL FUNCTIONSMaintains collective responsibility for the management of services provided by the Claims Appeals, Claims Medical Review and Subrogation Teams. Additionally, responsible for monitoring metrics and operations within these teamsResponsible for implementing best practices based on company goalsIdentify strategic opportunities based on financial analysis and projections, cost/benefit identification and analysisProvide support, guidance, leadership, and motivation to promote maximum performanceResponsible for preparing reporting and analysis that is consistent with defined standards and processesProvide technical guidance to staff on claim investigation, reserving evaluation and resolution of claimsPartner with analytical team to produce necessary results and trending reports for leadershipReview high dollar appeals, medical review referrals, and subrogation cases from members, providers, and other entitiesManage all aspects of the day-to-day operations of claims productionInteract extensively with various parties involved in the claim processRemain current and aware of impact on claims management strategiesCollaborate with other Claims and business leaders to define and drive enterprise initiativesAssist or prepare files for subrogationCreate an environment that encourages and values the opinions of others and promotes sharing of information and ideasOversee monitoring and tracking of individuals and the unit's performance against established productivity and quality goals and metrics.Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talentClearly communicate expectations, provide employees with the training, resources, and information needed to succeedActively engage, coach, counsel and provide timely, and constructive performance feedbackOther duties as assignedEDUCATIONBachelor’s degree or equivalent work experience requiredEXPERIENCE AND SKILLSAt least 5 years of TPA or group health insurance experience including at least 3 years at a supervisor level and successfully demonstrated leadership competenciesIn-depth knowledge of Claims, Benefits and administrative skills and processes required.Intermediate level work experience with Microsoft Office, Word, Excel, Access, and Power Point software applicationsThe ability to easily learn other software and systemsMust be able to write business correspondence and proceduresPOSITION COMPETENCIESAccountabilityCoaching and FeedbackCollaborationCustomer FocusDecision MakingExecution ManagementPeople LeadershipPHYSICAL DEMANDSThis is a standard desk job requiring extended sitting and computer work.WORK ENVIRONMENTRemoteHere at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.