The Claims Manager is responsible for leading and overseeing the organization's Active Claims and Litigated Claims functions. The Claims Manager is accountable for establishing departmental goals, key performance indicators (KPIs), and service standards; monitoring and reporting on individual and team performance; and driving operational excellence through data-informed decision-making.
As a people leader, the Claims Manager is responsible for recruiting, coaching, developing, and performance-managing team members while fostering a culture of accountability, collaboration, and continuous improvement. The role oversees daily operations, allocates resources effectively, identifies process improvement opportunities, and exercises independent judgment and leadership while ensuring departmental activities aligning with organizational goals and financial objectives.
What You'll Do- Lead and oversee the daily operations of the Active Claims and Litigated Claims teams, ensuring timely claim resolution, operational efficiency, and achievement of departmental performance goals.
- Partner with the Senior Director of Payer & Patient Relations and cross-functional leaders to develop and implement strategies that maximize collections, improve reimbursement outcomes, and enhance overall claims performance.
- Establish, monitor, and report on key performance indicators (KPIs), productivity metrics, quality standards, and aging benchmarks for both individual contributors and teams.
- Recruit, coach, develop, and manage staff, including supervisors, while fostering a culture of accountability, collaboration, continuous learning, and high performance.
- Analyze claims data, reimbursement trends, write-offs, denials, short payments, and other key metrics to identify opportunities for process improvement and revenue optimization.
- Lead departmental process improvement initiatives, leveraging trend analysis, audits, and performance reviews to enhance quality, productivity, and reimbursement results.
- Perform additional duties and strategic initiatives assigned in support of organizational goals.
What You'll Need to Succeed- Bachelor's degree or equivalent combination of education and relevant experience.
- Leadership experience in workers' compensation, healthcare collections, revenue cycle management, insurance, or a related claims environment.
- Proven success leading, coaching, and developing high-performing teams while driving productivity, quality, and reimbursement results.
- Strong negotiation, analytical, problem-solving, and decision-making skills, with the ability to resolve complex reimbursement and collection issues.
- Advanced computer proficiency, including experience with databases, Windows-based applications, reporting tools, and accounts receivable or claims management systems.
- Excellent verbal, written, presentation, and interpersonal communication skills, with the ability to effectively engage internal and external stakeholders at all levels.
- Strong business acumen with the ability to analyze collection and reimbursement trends, assess risk, develop actionable insights, and drive continuous process improvement initiatives
Your compensation will include a competitive salary, generous benefits, and opportunities for growth and development.
We are dedicated to attracting and retaining top talent with competitive and fair compensation. The salary range for this role is $75,000 - $95,000.
