Claims Operations Manager (Helena, MT)

Summary

The Claims Operations Manager is responsible for overseeing and managing the daily operations of the claims department. This role ensures the efficient and accurate processing of claims, compliance with regulatory requirements, and delivery of excellent customer service. The manager leads a team of claims professionals, implements process improvements, and collaborates with other departments and client to achieve organizational goals.

Your role in our mission

• Supervise and coordinate the daily operations of the claims department, ensuring timely and accurate claims processing.
• Establish and monitor performance metrics, service level agreements (SLAs), and department goals.
• Coach, mentor, and develop claims staff, including performance evaluations and training initiatives.
• Review and resolve complex or escalated claims issues, ensuring compliance with company policies and regulatory standards.
• Implement process improvements to enhance efficiency, accuracy, and customer satisfaction.
• Oversee the use of claims management systems and ensure data integrity and confidentiality.
• Collaborate with underwriting, customer service, legal, and finance teams to address interdepartmental issues and support business objectives.
• Prepare and present regular reports on claims operations, trends, and key performance indicators (KPIs) to senior management.
• Maintain up-to-date knowledge of industry regulations, trends, and best practices.
• Handle customer complaints and inquiries with professionalism, ensuring prompt resolution and positive outcomes.

What we're looking for

• Bachelor's degree in business administration, insurance or related field
• Five (5) or more years of healthcare (Medicaid/Medicare) claims processing or insurance operations experience
• Two (2) or more years of leadership or supervisory experience in a claims processing or insurance operations environment
• Proficient in claims management software and Microsoft Office Suite.
• Strong knowledge of healthcare insurance claims processes, and regulatory requirements.

What you should expect in this role

• Office environment in Helena, MT
• This is a full-time permanent regular salaried (W-2) employee position.
• Monday through Friday work schedule (may require extended hours during peak periods or to address urgent issues).
• Health (medical, dental, vision) benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
• Company provided computer for work use.
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
• This position will remain posted to take applications until March 16, 2026.

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