Strategic Claims Operations Lead

Alight Solutions Ltd; Vermont; Hybrid; USD 65,000 - 75,000; Full time

Job summary

Alight Solutions Ltd seeks a Claims Operations Manager to lead a claims team, align service goals with client commitments, and drive productivity, quality and customer satisfaction. This role emphasizes strategic oversight, accountability, and continuous improvement across STD/LTD programs.

You will supervise a virtual team, manage KPIs, and collaborate with care, administrative and clinical colleagues to deliver compliant, efficient service while supporting client requirements and SLAs.

Qualifications

• Have leadership experience of three or more years in STD/LTD product and claims management knowledge.
• Demonstrate the proven ability to manage both day-to-day execution and projects to achieve results of business goals and special assignments.
• Possess an associate degree or equivalent professional work experience.
• Display excellent communication and relationship-building abilities.
• Have previous supervisory experience and the ability to prioritize and assign work.
• Have advanced level computer skills using Windows and Microsoft Office suite of programs including Word, Excel, PowerPoint and Outlook.
• Show technical proficiency by utilizing technology, data, and business tools to foster innovation, boost efficiency, support decision-making, and enhance customer experience.
• Display expert critical thinking skills with proven analytical business acumen.
• Have creative agility to address complex business and technical challenges.

Responsibilities

• Facilitating communication among the Customer Care, Administrative, and Clinical teams. This would extend to employees, client companies, healthcare providers, and clinical partners, for STD and FMLA absence programs.
• Ensuring legal compliance and confidentiality by providing timely notifications to employees and client organizations.
• Reviewing documentation to support claim approvals and denials and responding to audit requests in accordance with regulatory and company requirements.
• Acting as a Subject Matter Expert for Alight's Leave of Absence programs, offering guidance on policies, processes, and client requirements. Ensuring accurate, compliant service delivery and assisting with resolving complex cases.
• Leading a virtual team, defining roles and responsibilities and establishing direct accountabilities to achieve business goals. Building talent and people capability to enable a high-quality culture.
• Providing ongoing client support with the use of diagnostic skills to identify root cause of client issues. Developing solutions and recommending appropriate action to prevent recurrence of problems.
• Managing team performance against established Key Performance Indicators (KPIs) and ensuring all service and performance guarantees are consistently achieved.
• Overseeing day-to-day operations, including workload distribution, performance management, employee development, and goal setting to drive business results.
• Responding timely and accurately to client and internal inquiries, according to established standards with attention to style, tone, and manner of communication. Participating appropriately in client meetings and implementations.
• Monitoring and maintaining staff schedule adherence while ensuring timely communication of new and updated processes, procedures, and operational changes.

Skills

Leadership

Communication

Supervisory experience

Analytical thinking

Problem solving

Education

Associate degree or equivalent experience

Tools

Windows

Microsoft Office

Job description

Alight Solutions Ltd seeks a Claims Operations Manager to lead a claims team, align service goals with client commitments, and drive productivity, quality and customer satisfaction. This role emphasizes strategic oversight, accountability, and continuous improvement across STD/LTD programs.

You will supervise a virtual team, manage KPIs, and collaborate with care, administrative and clinical colleagues to deliver compliant, efficient service while supporting client requirements and SLAs.