Claims Manager

About The Role

The Claims Manager leads the strategic oversight of the claims function, focusing on team performance, process optimization, and quality outcomes. This role provides high-level coaching, mentoring, and training to team members to drive continuous improvement. The Manager identifies and implements enhancements to workflows, systems, and policies to improve operational efficiency and service delivery. They are responsible for setting performance expectations, monitoring results, and fostering professional development across the team. The role requires strong decision-making skills, the ability to manage competing priorities, and effective collaboration with cross-functional leaders to support organizational goals. This is an office- based position requiring work to be performed on-site.

Key Responsibilities

• Effectively manage remote and office-based teams, promoting strong leadership and employee engagement.
• Manages a unionized staff, ensuring adherence to collective bargaining agreements while fostering a collaborative and accountable work environment.
• Provide comprehensive support for claims, appeals, internal departments, vendors, and customers.
• Daily workload distribution and monitoring for timely resolution.
• Conduct and/or support training for new hires, vendors, and existing staff.
• Staff performance monitoring and management.
• Monitor and evaluate claims performance to identify trends and areas for improvement.
• Handle escalated issues and process high-value claims and adjustments.
• Identify process improvement opportunities and establish supporting workflows.
• Review and ensure quality of claims and logic changes in the claims processing systems and applications.
• Coach employees to exceed quality and productivity standards, addressing performance issues.
• Conduct audits and manage payroll, schedules and time off requests.
• Document and address performance concerns and conduct quarterly evaluations.
• Perform focus audits, creation of ad hoc reports and result summaries for management and/or client.
• Regularly conduct individual and team meetings.
• Must be adaptable and willing to provide backup leadership support across various departments and teams as needed.

Essential Qualifications

• 5+ years in a leadership role—preferably claims.
• Advanced knowledge of Microsoft Office (Word and Excel).
• 5+ years of advanced claims adjudication experience including facility, professional and ancillary claims is required.
• Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required.
• Strong problem solving/analysis skills.
• Organizational skills: ability to effectively prioritize and multitask.
• Ability to establish and maintain positive and effective work relationships with clients, coworkers, members, providers and customers.
• Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
• Bachelor’s Degree preferred or comparable experience in the healthcare field.
• Bilingual preferred.

At MagnaCare LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

For more than 30 years, MagnaCare LLC has been a trusted partner in delivering flexible, customized solutions for self-insured organizations. As a national third-party administrator (TPA), we combine proprietary technology, network expertise, and a deep understanding of labor to help our clients achieve their goals while supporting the people they serve.

Our focus on labor means we work closely with funds, Taft-Hartley Trusts, and other self-insured groups to deliver tailored solutions that go beyond the basics. From health plan administration and eligibility management to contribution accounting, we provide the tools and support organizations need to succeed. With specialized offerings such as flexible network administration, direct contracting, in-house medical and care management, and workers’ compensation programs, we create benefit plans that address unique needs with precision.

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