Claims Systems Manager

Partners Health Management

. Provide strategic leadership and oversight to the Claims Systems Analyst Supervisor(s) team .

Posted 10/14/2026full-timeRemote • United StatesSeniorLead💰 $99,963 - $129,952 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strategic leadership in managing claims systems and teams, with a strong focus on project management, vendor relationship management, and compliance with North Carolina Medicaid regulations. Proficient in claims management software and business analysis techniques to drive organizational goals and enhance operational efficiency.

Highest-signal resume keywords

Claims Management Software ProficiencyProject Management MethodologiesVendor Relationship ManagementBusiness Requirement Document ManagementLeadership in Team Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Processing SoftwareData Analysis ToolsProject Management SoftwareBusiness Analysis TechniquesReport CreationPivot TablesPresentation SkillsConflict Resolution MethodsStrategic Roadmap DevelopmentCompliance Knowledge

Soft Skills

Exceptional Written CommunicationExceptional Verbal CommunicationAnalytical Problem-SolvingAttention to DetailRelationship Building

Tools & Technologies

Microsoft O365 SuiteService Desk Ticketing Software

Industry Keywords

Health Insurance SystemsNorth Carolina Medicaid RegulationsInsurance PrinciplesFederal and State RegulationsClaims Management Technologies

About the role

Key responsibilities & impact

Provide strategic leadership and oversight to the Claims Systems Analyst Supervisor(s) team
Hire, supervise, evaluate, and mentor the Claims System Analyst team
Monitor workload and business requirements to maintain adequate staffing and productivity
Facilitate the design, development, implementation, and operation of claims management and associated software systems
Provide daily status updates to upper management as directed by the VP of Business Services
Monitor, track, and escalate Business Requirements Documents, vendor contracts, and service desk ticket resolution
Oversee and participate in software application selection, implementation, and maintenance
Allocate project and support resources in alignment with divisional and organizational priorities
Complete project reports and documentation on project health and status
Develop and communicate organizational vision and direction to the Claims System team and stakeholders
Ensure complex projects align with ISD architecture, infrastructure, and business goals
Identify and define the claims management system vision, roadmap, and growth opportunities
Evaluate and prioritize feature backlogs and development requests
Manage vendor relationships and act as an escalation point for staff and stakeholders
Coordinate across ISD teams to prioritize and deliver projects, reports, and enhancements within stated timeframes
Ensure claims management technologies are used according to policies and procedures
Apply knowledge of North Carolina Medicaid rules and regulations
Perform other duties as assigned

Requirements

What you’ll need

Bachelor’s degree in Business Administration, Information Systems Management, Health Information Management, or closely related field
Seven (7) years of experience in management of data systems, with focus on claims or health insurance systems a plus
Minimum of five (5) years of experience in a management/supervisory role
In-depth understanding of physical and behavioral health claims processing software systems
Knowledge of insurance principles, practices, federal and state regulations, and North Carolina Medicaid rules and laws
Understanding of project management methodologies and tools
Knowledge of business analysis techniques and tools, including creation and management of Business Requirement Documents
Proven ability to lead and manage medium to large teams effectively
Exceptional written and verbal communication skills
Excellent analytical and problem-solving skills
Proficiency with claims management software, data analysis tools, project management software, Microsoft O365 suite, and service desk ticketing software
Ability to create reports, pivot tables, and presentations
Ability to manage vendor relationships and use conflict resolution methods
Ability to define and implement strategic roadmaps aligned with organizational goals
Keen attention to detail and ability to ensure accuracy and compliance
Ability to make informed decisions quickly and effectively
Ability to cultivate working relationships with internal and external stakeholders
Must live in Florida, Georgia, Maryland, North Carolina, South Carolina, Tennessee, or Virginia

Benefits

Comp & perks

Annual incentive bonus plan
Medical, dental, and vision insurance with low deductible/low cost health plan
Generous vacation and sick time accrual
13 paid holidays
State Retirement (pension plan)
401(k) Plan with employer match
Company paid life and disability insurance
Wellness Programs
Public Service Loan Forgiveness Qualifying Employer