Claims Manager

Responsibilities: Direct the day-to-day activities of the claims function, ensuring processing timeliness, quality standards, and departmental performance goals are consistently achieved. Lead, coach, and develop claims staff by managing onboarding, work allocation, performance feedback, and ongoing training efforts. Design and refine departmental procedures and claim handling standards to support efficient workflows, reliable outcomes, and alignment with regulatory and organizational expectations. Maintain health plan configurations within the claims platform and verify updates are accurately reflected in processing rules and setup. Coordinate system-related claim processing updates, including edit changes and related enhancements, to support accurate adjudication and operational continuity. Produce and review operational reports on a daily, weekly, and monthly basis to track productivity, monitor turnaround times, and help balance team workload. Analyze claims activity and departmental results to identify improvement opportunities and support informed decision-making. Stay informed on changes in insurance regulations, claims practices, and industry standards, applying updates to internal processes as needed.