Claims Manager

Avēsis

. Provide direct oversight of Claims Supervisors, processing staff, claims processing workflows, queue management and daily transactional operations .

Posted 10/28/2026full-timeRemote • United StatesMid-LevelSenior💰 $74,260 - $145,250 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims processing oversight, including managing workflows, employee performance, and operational improvements. Proficient in claims adjudication systems and knowledgeable in Medicare, Medicaid, and commercial insurance processes.

Highest-signal resume keywords

Claims Processing OversightClaims Adjudication System LogicMicrosoft Office ProficiencySupervisory ExperienceKnowledge of Medicare and Medicaid

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims Processing WorkflowsClaims Adjustment ManagementCPT CodingHCPC CodingDental CodingData AnalysisOperational Improvement PlansQuality Standards MonitoringEmployee Performance ManagementAuto-Adjudication Triggers

Soft Skills

Excellent Communication SkillsStrong Attention to DetailOrganizational SkillsListening SkillsAbility to Manage Multiple Tasks

Tools & Technologies

Microsoft ExcelMicrosoft WordAdobeWindows-Based Tools

Industry Keywords

Claims ProcessingHealthcare OrganizationsDental/Vision InsuranceInsurance TerminologyRegulatory Compliance

Tech Stack

Tools & technologies

RPA

About the role

Key responsibilities & impact

Provide direct oversight of Claims Supervisors, processing staff, claims processing workflows, queue management and daily transactional operations
Oversee timely and accurate claims processing within contractual and regulatory time frames
Interview, select and hire applicants for Claims department positions
Manage employee performance, set goals, oversee workloads, and monitor productivity, metrics and quality
Monitor claims inventory and address areas of concern with Claims Supervisors
Plan and assign employee job requirements and develop team goals and objectives
Ensure quality and productivity standards are monitored and feedback is provided
Resolve aged claims and manage claims adjustment projects
Present claims processing reviews, policy updates, audit findings and related communications in team meetings
Identify opportunities and oversee implementation of operational improvement plans
Support internal and external audit activity
Maintain departmental workflows, standard operating procedures and employee performance review processes
Communicate with internal stakeholders regarding pending or open deliverables
Present data, analysis and solutions concerning processing trends, improvement opportunities, concerns, turnaround times and quality benchmarks to the Claims Executive Leadership Team
Perform other duties as assigned

Requirements

What you’ll need

Bachelor's degree or equivalent combination of education and experience
Minimum 5 years supervisory or management experience leading a production team
Minimum 3+ years’ experience leading or participating in development of claim enhancements, including auto-adjudication triggers, robotic process automation and claims adjudication system logic
Knowledge of Medicare, Medicaid, and/or Commercial insurance terminology and high-level claims payment processes
Advanced proficiency in Microsoft Office products, including Excel, Word, Adobe, and other Windows-based tools used to aggregate, analyze, trend and report recommendations
Ability to work flexible hours to accommodate business needs in all time zones
Excellent listening and verbal and written communication skills
Exposure/experience to CPT, HCPC, dental and diagnosis coding
Knowledge of general claims processing principles
Strong attention to detail and accuracy
Strong organizational skills with ability to manage multiple tasks and meet deadlines
Reliable internet service; 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient
Master's degree in a related field preferred
Experience within Dental/Vision insurance or healthcare organizations preferred

Benefits

Comp & perks

Competitive compensation package
Medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period
Life and disability insurance
401(k) with company match
Tuition assistance
Paid parental leave
Backup family care
Flexible time off
Flexible dress code and work location policies
Employee Resource Groups
Social responsibility and community volunteering opportunities
Meaningful and challenging work opportunities
Dynamic, modern work environments that promote collaboration and creativity