The Supplemental Health Claims Manager is an individual contributor responsible for providing subject matter expertise to design, implement, and continuously improve supplemental health claims processes, procedures, and workflows. This role partners closely with Claims Operations, Product, Compliance, Training, and Technology teams to ensure customer-focused, compliant, and efficient claims practices. The position may also adjudicate claims and support quality initiatives as needed.
Key Responsibilities: - Process, procedure, and workflow design: Lead the development and implementation of new and revised supplemental health claims processes, standard operating procedures (SOPs), desk-level job aids, workflow diagrams, and controls to support consistent, scalable operations.
- Technical claims subject matter expertise: Serve as the go-to expert for supplemental health products (Accident, Critical Illness, Hospital Indemnity, Wellness, etc.) and interpret plan provisions, definitions, limitations, exclusions, riders, and administrative rules to guide accurate claims outcomes.
- Systems design and requirements support: Partner with Technology and business stakeholders to translate operational needs into clear requirements (rules, routing, templates, decision logic, edits, and reporting), validate design, and support testing (UAT) to ensure systems enable compliant and efficient claims processing.
- Eligibility and efficiency optimization: Identify opportunities to improve eligibility verification, evidence collection, and straight-through processing; recommend automation and controls to reduce rework, turnaround time, and preventable denials while maintaining accuracy and customer experience.
- Training and knowledge enablement: Contribute to training program development by creating curriculum content, job aids, and scenario-based learning; deliver or support training for new hires and tenured staff on product knowledge, systems, and procedure changes.
- Continuous improvement and quality: Analyze operational performance (e.g., turnaround time, accuracy, denial drivers, customer contacts), support root-cause investigations, and implement corrective actions; participate in audits and quality reviews to sustain high standards.
- Regulatory compliance and industry awareness: Stay current on applicable federal/state regulations, market trends, and internal compliance requirements; assess impacts to claims handling and proactively recommend updates to procedures, controls, training, and communications.
- Claims adjudication (as assigned): Review and adjudicate supplemental health claims in accordance with plan provisions and procedures
Required Qualifications- Bachelor's degree (or equivalent combination of education and related experience).
- 3+ years of experience in supplemental health (voluntary benefits) claims operations and/or claims adjudication (Accident, Critical Illness, Hospital Indemnity, Wellness, etc.).
- Experience with process improvement methods, service-level management, and quality/audit programs.
- Experience creating and maintaining operational documentation (SOPs, workflows, job aids) and communicating process changes to stakeholders.
- Experience supporting implementations or migrations of claims platforms (requirements, configuration support, testing, training, go-live readiness).
- Demonstrated training facilitation experience (live sessions, virtual training, train-the-trainer).
- Demonstrated ability to interpret plan provisions/contract language and apply it consistently to claim scenarios.
- Working knowledge of claims systems and operational controls (queue routing, decision rules, correspondence templates, work item management) and participation in testing/UAT.
- Ability to analyze operational issues, identify root causes, and implement improvements that enhance accuracy, compliance, and cycle time.
- Strong written and verbal communication skills, with the ability to explain claim outcomes and technical concepts clearly and professionally.
Preferred Qualifications- Experience applying Lean and Six Sigma methodologies to drive process improvements
Salary Band: 6A
#LI-SC1
This selected candidate will be expected to work hybrid in Indianapolis, IN or Portland, ME. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team building and collaboration.
We offer a comprehensive total rewards package designed to support you both at work and at home. Full-time and part-time associates working 30 or more hours per week are generally eligible for benefits, including but not limited to:
- Medical & prescription, dental, vision insurance
- Health Savings Account & Flexible Spending Accounts
- Paid Time Off
- 10 weeks 100% paid parental leave (after completing 12 months of employment)
- 401(k) Plan with company match
- Pension Plan
- Company paid life & disability insurance
- Wellness Program & Company paid employee assistance program
- Clinic access subject to location* (*Indianapolis, Charlotte, Cincinnati)
