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Manager, Claims Operations
Allied Benefit Systems. Manage day-to-day operations of the Claims Appeals, Claims Medical Review, and Subrogation Teams .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong leadership and management capabilities in overseeing Claims Appeals, Claims Medical Review, and Subrogation Teams while ensuring operational efficiency and adherence to company goals. Proficient in financial analysis, reporting, and developing talent to achieve productivity and quality objectives.
Highest-signal resume keywords
Claims ManagementLeadership ExperienceFinancial AnalysisMicrosoft Office ProficiencyTPA or Group Health Insurance Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ManagementFinancial AnalysisReporting and AnalysisClaims InvestigationReserving EvaluationClaim ResolutionPerformance AppraisalsBusiness CorrespondenceCost/Benefit AnalysisProductivity Metrics
Soft Skills
LeadershipMotivationCoachingCollaborationCommunication
Tools & Technologies
Microsoft WordMicrosoft ExcelMicrosoft AccessMicrosoft PowerPoint
Industry Keywords
Claims AppealsClaims Medical ReviewSubrogationTPAGroup Health Insurance
About the role
Key responsibilities & impact- Manage day-to-day operations of the Claims Appeals, Claims Medical Review, and Subrogation Teams
- Monitor team metrics and operations
- Implement best practices based on company goals
- Identify strategic opportunities through financial analysis, projections, and cost/benefit analysis
- Provide support, guidance, leadership, and motivation
- Prepare reporting and analysis according to defined standards and processes
- Provide technical guidance on claim investigation, reserving evaluation, and claim resolution
- Partner with the analytical team to produce results and trending reports for leadership
- Review high-dollar appeals, medical review referrals, and subrogation cases
- Manage claims production operations and interact with parties involved in claims
- Collaborate with Claims and business leaders on enterprise initiatives
- Prepare files for subrogation
- Oversee individual and unit performance against productivity and quality goals
- Lead, coach, motivate, and develop employees
- Conduct one-on-one meetings and performance appraisals
- Provide training, resources, expectations, and constructive performance feedback
- Attract and develop new talent
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor’s degree or equivalent work experience required
- At least 5 years of TPA or group health insurance experience
- At least 3 years at a supervisor level
- Successfully demonstrated leadership competencies
- In-depth knowledge of Claims, Benefits, and administrative skills and processes
- Intermediate-level experience with Microsoft Office, Word, Excel, Access, and PowerPoint
- Ability to easily learn other software and systems
- Ability to write business correspondence and procedures
- Internet service through cable broadband or fiber optic provider with at least 100 Mbps download/25 Mbps upload
- Extended sitting and computer work required
Benefits
Comp & perks- Medical Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Disability Insurance
- Generous Paid Time Off
- Tuition Reimbursement
- Employee Assistance Program (EAP)
- Technology Stipend
- Flexible remote work from home