Senior Claims Operations Leader - Remote

Insurance Administrative Solutions, L.L.C.; Clearwater (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

Integrity, LLC is seeking a Claims Department Manager to lead day-to-day claims operations, supervise staff, and drive performance in a fast-paced environment. You will oversee reporting, compliance, and process improvements while partnering with executives to align with strategic initiatives.

The role requires 5+ years in health claims operations, strong leadership and communication abilities, and proficiency with claims systems and MS Office.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, Insurance, or related field preferred; equivalent education and relevant experience may be considered.
• Minimum five (5) years of proven experience in the health insurance industry with progressive responsibility in health claims operations.
• Demonstrated leadership experience managing supervisors and multiple operational teams.
• Familiarity with medical terminology, procedure codes, diagnosis codes, and healthcare claims processing practices preferred.
• Proficiency with Microsoft Office applications, including Word and Excel.
• Experience with claims administration systems, workflow management tools, and related operational technologies preferred.
• Demonstrated ability to interpret policy provisions, benefits, eligibility requirements, and claims payment methodologies.
• Strong analytical, problem-solving, and decision-making skills.
• Excellent verbal, written, and interpersonal communication skills.
• Ability to manage competing priorities and meet deadlines in a fast-paced environment.

Responsibilities

• Participate in operational planning, workforce planning, and resource allocation to support Claims Department objectives.
• Oversee preparation, analysis, and distribution of operational, client, regulatory and management reports.
• Monitor claim payment accuracy, quality, productivity, inventory levels, turnaround times and service level performance; implement corrective actions when needed.
• Ensure department policies, procedures, workflows, and controls are consistently applied and updated.
• Maintain understanding of company policies and operational processes impacting claims operations and staff performance.
• Plan, direct, coordinate, and evaluate department workflows, priorities and special projects.
• Train, coach, mentor, and evaluate direct reports, fostering development and accountability.
• Lead user acceptance testing (UAT), implementation activities, and readiness reviews for claims-related projects.
• Partner with HR on hiring, development, performance management, promotions, and succession planning.
• Support strategic initiatives including system implementations, client conversions, and regulatory requirements.
• Oversee departmental initiatives and ensure timely execution of goals and deliverables.
• Maintain knowledge of claims administrative systems, workflows, interfaces, and integrations.
• Collaborate with internal partners to define and implement business requirements.
• Build and maintain relationships with other department managers and staff.

Skills

Leadership experience

Analytical skills

Communication skills

Problem solving

Attention to detail

Travel flexibility

Education

Bachelor’s degree in Healthcare Administration, Business Administration, Insurance, or related field

Tools

Microsoft Office (Word, Excel)

Claims administration systems

Job description

Integrity, LLC is seeking a Claims Department Manager to lead day-to-day claims operations, supervise staff, and drive performance in a fast-paced environment. You will oversee reporting, compliance, and process improvements while partnering with executives to align with strategic initiatives.

The role requires 5+ years in health claims operations, strong leadership and communication abilities, and proficiency with claims systems and MS Office.