Remote Claims Operations Leader

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

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off

Tuition Reimbursement

EAP

Technology Stipend

Job summary

Allied Benefit Systems seeks a Manager of Claims Operations to lead the Claims Appeals, Claims Medical Review, and Subrogation teams, driving operational excellence and adherence to service level metrics. The role partners with analytics and leadership to implement best practices, review high-dollar cases, and develop staff through coaching and performance feedback while supporting remote work.

This leadership role requires strategic thinking, strong communication, and a proven track record in

Qualifications

• 5+ years of TPA or group health insurance experience including at least 3 years at a supervisor level.
• Knowledge of Claims, Benefits and administrative processes.
• Proficient with Microsoft Office suite.

Responsibilities

• Maintain collective responsibility for the management of services provided by the Claims Appeals, Claims Medical Review and Subrogation Teams.
• Monitor metrics and operations within these teams.
• Identify strategic opportunities based on financial analysis and projections, cost/benefit identification.
• Provide support, guidance, leadership, and motivation to promote maximum performance.
• Prepare reporting and analysis consistent with defined standards and processes.
• Provide technical guidance to staff on claim investigation, reserving evaluation and resolution of claims.
• Collaborate with analytical team to produce results and trending reports for leadership.
• Review high-dollar appeals, medical review referrals, and subrogation cases from members, providers, and other entities.
• Manage all aspects of the day-to-day operations of claims production.
• Interact extensively with various parties involved in the claim process.
• Remain current on impact on claims management strategies.
• Collaborate with other Claims and business leaders to drive enterprise initiatives.
• Assist or prepare files for subrogation.
• Create an environment that encourages the sharing of information and ideas.
• Oversee monitoring and tracking of performance against productivity and quality goals and metrics.
• Lead, coach, motivate and develop staff; conduct performance appraisals and growth opportunities.
• Communicate expectations and provide training, resources, and information needed to succeed.
• Engage, coach, counsel and provide timely performance feedback.
• Other duties as assigned

Skills

Leadership

Communication

Project management

Business writing

Education

Bachelor’s degree or equivalent work experience

Tools

Microsoft Office

Excel

PowerPoint

Access

Job description

Allied Benefit Systems seeks a Manager of Claims Operations to lead the Claims Appeals, Claims Medical Review, and Subrogation teams, driving operational excellence and adherence to service level metrics. The role partners with analytics and leadership to implement best practices, review high-dollar cases, and develop staff through coaching and performance feedback while supporting remote work.

This leadership role requires strategic thinking, strong communication, and a proven track record in