Supervise and coordinate the daily operations of the claims department, ensuring timely and accurate claims processing.
Establish and monitor performance metrics, service level agreements (SLAs), and department goals.
Coach, mentor, and develop claims staff, including performance evaluations and training initiatives.
Review and resolve complex or escalated claims issues, ensuring compliance with company policies and regulatory standards.
Implement process improvements to enhance efficiency, accuracy, and customer satisfaction.
Oversee the use of claims management systems and ensure data integrity and confidentiality.
Collaborate with underwriting, customer service, legal, and finance teams to address interdepartmental issues and support business objectives.
Prepare and present regular reports on claims operations, trends, and key performance indicators (KPIs) to senior management.
Maintain up-to-date knowledge of industry regulations, trends, and best practices.
Handle customer complaints and inquiries with professionalism, ensuring prompt resolution and positive outcomes.

Bachelor's degree in business administration, insurance or related field
Five (5) or more years of healthcare (Medicaid/Medicare) claims processing or insurance operations experience
Two (2) or more years of leadership or supervisory experience in a claims processing or insurance operations environment
Proficient in claims management software and Microsoft Office Suite.
Strong knowledge of healthcare insurance claims processes, and regulatory requirements.

Health (medical, dental, vision) benefits start on day 1 of employment.
Company match 401K and other benefits available within months of starting.
New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment.
Company provided computer for work use.

Claims Operations Manager

Key skills