Claims Manager

Salary: $95,000 – $135,000+ (negotiable) + Bonus

Location: Onsite in Clearwater, FL – relocation assistance available

Summary

Our client is seeking a Claims Manager to lead claims operations within a fast-paced Third Party Administrator environment. This role oversees claims processing, examiner performance, and operational strategy while ensuring accuracy, SLA compliance, and excellent client service. This position manages claims leadership, technology, vendor relationships, and department performance while partnering with leadership to improve efficiency and automation. This role has two direct reports (2 supervisors) and 30 indirect reports (claims analysts/processors/examiners).

What You'll Do

Lead Claims Operations Oversee daily claims processing and ensure accuracy across all processing stages Monitor examiner productivity and establish production standards Manage escalations and approve high-dollar claims Ensure compliance with SLAs, turnaround times, and quality standards Improve Systems and Automation Drive automation initiatives, including electronic claim intake and auto-adjudication Oversee claims processing systems and benefit configuration updates Support the development and implementation of operational improvements Manage the Claims Team Lead and develop the Claims Department management team Participate in hiring, training, and performance management Establish policies, procedures, and documentation standards Client and Vendor Collaboration Serve as a primary contact for escalations and service issues Support RFP responses, product development, and vendor selection Manage relationships with PPOs, reference-based pricing vendors, clearinghouses, and other partners

What We're Looking For 5 to 7+ years of health insurance or benefits claims operations leadership experience Third Party Administrator experience required Must have commercial experience (not workers comp, and not Medicare/Medicaid) Strong understanding of automated claims adjudication Experience working with network vendors or reference-based pricing preferred Strong leadership, communication, and operational management skills Bachelor's degree preferred,