Claims Manager - Captrue Benefits

A CAREER AT CAPTRUE BENEFITS

Working at Captrue Benefits, you’ll experience a culture that is made up of a group of people who are supportive, innovative, collaborative, and caring towards each other and the customers we serve. Captrue Benefits is looking for a Claims Auditor/Stop Loss Specialist to join our team. This is a full-time remote position. Join our team and help us change the way healthcare is financed, disclosed and delivered.

OUR VISION FOR THIS KEY ROLE

The Claims Manager oversees the Claims Department, ensuring timely, accurate, and compliant processing of healthcare claims and stop loss coordination. This role provides daily leadership, technical expertise, and cross-functional collaboration while driving continuous improvements in efficiency, quality, workflows, and cost management. The manager develops staff, creates and maintains department policies/procedures, supports regulatory compliance, manages high-cost claims and appeals, analyzes performance trends, and partners with internal and external stakeholders to advance operational goals.

A SAMPLE OF WHAT YOU'LL GET TO DO IN THIS JOB

• Lead, coach, train and manage claims staff; oversee workload distribution and performance.
• Resolve complex and escalated claim issues.
• Oversee adjudication, research, appeals, disputes, and escalations.
• Serve as SME for complex claims and coverage interpretation.
• Develop and execute strategies to optimize auto-adjudication in partnership with Plan Building team.
• Ensure compliance with ERISA, HIPAA, other applicable state/federal rules, and plan requirements.
• Review, analyze and process appeals in accordance with regulatory guidelines and benefit plan requirements.
• Analyze trends, errors, and system issues; identify root causes and improvement opportunities.
• Participate in system updates, UAT, and defect resolution with IT and vendors.
• Work with providers, members, and internal teams to resolve claim and reimbursement issues.
• Support staff education, benefit interpretation, and cross-functional coordination.

WHAT YOU'LL BRING TO THE JOB

· Bachelor’s degree preferred; associate degree or equivalent experience accepted.

· 5-7 years of healthcare claim processing experience is required including thorough knowledge of coding structures (CPT, HCPCS, Revenue codes, ICD 9/10 etc.); as well as COB payments and distribution of funds.

· Understanding all types of claims pricing (Network, Medicare, UCR, etc.)

· Stop loss experience including understanding of contract types, reimbursement features/terms and claims filing requirements.

· 2–5+ years of supervisory/leadership experience.

· Familiarity with VBA Software claims systems strongly preferred but not required.

· Strong analytical, communication, and problem-solving skills; ability to manage high-volume priorities.

WHO WE ARE

Captrue Benefits is a third-party administrator located in Minneapolis, Minnesota. Captrue Benefit’s mission is to change the way healthcare is financed, disclosed and delivered. We need people who value honesty and transparency; people who take ownership and responsibility of whatever they are doing. We seek individuals who value all people and interact with humility and respect; people who like to dig deep into issues, who are curious and who understand life is about more than work. If you believe in our mission and share our Core Values, then we would like to talk about how we can make a positive impact together.

To apply directly with employer: https://recruiting.paylocity.com/recruiting/jobs/Details/3908270/TPAC-Underwriters/Claims-Manager

Pay: $80,000.00 - $110,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Paid training
• Parental leave
• Prescription drug insurance
• Tuition reimbursement
• Vision insurance

Work Location: Remote