Medical Claims Manager

Frederick Fox; Orlando (FL); On-site; USD 100,000 - 150,000; Full time

Job summary

A well-regarded organization seeks a Medical Claims Manager in Orlando, Florida. This pivotal role involves supervising the claims processing team to ensure accuracy and adherence to regulations. Ideal candidates possess leadership skills, experience with Third Party Administrators, and strong analytical capabilities, making this an excellent opportunity for career advancement.

Qualifications

• Previous experience with a Third Party Administrator (TPA) is required.
• Demonstrated leadership and problem-solving abilities.
• Familiarity with health-related claim types.

Responsibilities

• Supervise daily activities within the claims function.
• Lead and mentor a team to meet performance goals.
• Provide guidance on complex claim issues.

Skills

Leadership

Problem-Solving

Communication

Organizational

Analytical

Education

Bachelor's degree

Job description

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Base pay range

$100,000.00/yr - $150,000.00/yr

Position Summary:

Our client is looking for a Medical Claims Manager to lead a team within a healthcare claims environment. This full-time leadership role focuses on ensuring accurate and timely claims handling while overseeing a group responsible for processing and auditing functions.

Key Responsibilities:

• Supervise day-to-day activities within the claims function
• Lead and mentor a team to meet performance goals and maintain quality standards
• Provide guidance on complex or escalated claim issues
• Collaborate cross-functionally with other internal departments
• Track key metrics related to processing time and overall department performance
• Support resolution of appeals and other specialized claims matters
• Maintain adherence to applicable healthcare regulations and internal policies
• Contribute to staff training and help refine departmental procedures

Qualifications:

• Previous experience working with or for a Third Party Administrator (TPA)
• Demonstrated leadership and problem-solving abilities
• Familiarity with a range of health-related claim types (e.g., medical, dental, disability)
• Working knowledge of claims audits, appeals processes, and regulatory requirements
• Strong communication, organizational, and analytical skills
• Bachelor's degree preferred

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Management

• Industries

  Insurance and Hospitals and Health Care

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