claims manager

The Home Depot

<div>
 
 
 Position Purpose:
 
 
 
 Responsible for defining, implementing, and managing internal claims programs (self-administration) to control quality and costs associated with general liability claims (e.g. customer bodily injury and property damage). This position ensures the company&rsquo;s claims are handled internally in compliance with industry best practices and company policies, without reliance on a third-party administrator.
 
 
 
 
 
 
 Key Responsibilities:
 
 
 <ul>
 <li>
 25% Claims Handling Standards - Develops and enforces claims handling standards and best practices and oversees quality assurance programs (e.g. file reviews and audits) to ensure adherence to those standards. Drives continuous improvement in claims processes and outcomes under the self-administration model.
 </li>
 <li>
 30% Claims Operations Management - Leads the day-to-day operations of a multi-line general liability claims unit, ensuring consistent application of departmental standards, policies, and procedures. Oversees claim intake, investigation, and resolution processes to maintain efficiency and compliance with service and quality benchmarks. Drives cost containment initiatives, including management of allocated expenses on claims. Monitors loss costs and implement strategies to reduce average claim costs while maintaining fairness and compliance (such as early resolution programs, subrogation efforts, etc.).
 </li>
 <li>
 10% Settlement Authority Oversight - Assumes oversight for all claim settlements and reserve decisions within designated authority levels &ndash; reviewing and approving settlements in accordance with company guidelines. Reviews written settlement evaluations and escalates to the appropriate approval level in the organization when required.
 </li>
 <li>
 10% Stakeholder Communication - Establishes clear interface guidelines and communication channels among all parties involved in claims, including the internal claims team (examiners/adjusters), store management, associates, and the Legal department. Regularly communicates claim status and trends to senior management and other stakeholders.
 </li>
 <li>
 25% Team Leadership - Manages and develops the in-house claims staff. Responsible for the selection, training, performance appraisal, and professional development of direct reports. Fosters a high-performance team culture and provides coaching and guidance to ensure adjusters meet regulatory requirements and company performance standards.
 </li>
 </ul>
 
 
 
 
 
 Direct Manager/Direct Reports:
 
 
 <ul>
 <li>
 This Position typically reports to Senior Claims Manager.
 </li>
 <li>
 This Position may have direct reports.
 </li>
 </ul>
 
 
 
 
 
 Travel Requirements
 
 :
 
 <ul>
 <li>
 Typically requires overnight travel 5% to 20% of the time.
 </li>
 </ul>
 
 
 
 
 
 Physical Requirements:
 
 
 <ul>
 <li>
 Most of the time is spent sitting in a comfortable position and there is frequent opportunity to move about. On rare occasions, there may be a need to move or lift light articles.
 </li>
 </ul>
 
 
 
 
 
 Working Conditions:
 
 
 <ul>
 <li>
 Located in a comfortable indoor area; any unpleasant conditions would be infrequent and not objectionable.
 </li>
 </ul>
 
 
 
 
 
 Minimum Qualifications:
 
 
 <ul>
 <li>
 Must be eighteen years of age or older.
 </li>
 <li>
 Must be legally permitted to work in the United States.
 </li>
 <li>
 Demonstrated supervisory and team management experience in the insurance claims field, with ability to mentor adjusters and implement efficient claims handling processes. Strong leadership abilities evidenced by building effective teams and improving workflow.
 </li>
 </ul>
 
 
 
 
 
 Preferred Qualifications:
 
 
 <ul>
 <li>
 Industry Knowledge: In-depth knowledge of casualty claims best practices, legal compliance (fair claims practices, state regulations), and claims quality control techniques (e.g. file audit and review programs). Capable of establishing and upholding rigorous standards for internal claims operation.
 </li>
 <li>
 Analytical &amp; Communication Skills: Excellent analytical and critical thinking skills to evaluate claim information and make sound decisions quickly. Effective negotiation and communication skills, enabling successful settlement negotiations and collaboration with internal and external stakeholders (customers, attorneys, insurers).
 </li>
 <li>
 Bachelor&rsquo;s degree in risk management, Insurance, Business, or related field preferred (or equivalent industry experience).
 </li>
 <li>
 Professional development in insurance claims or risk management (e.g. industry certifications) is a plus.
 </li>
 </ul>
 
 
 
 
 
 Minimum Education:
 
 
 <ul>
 <li>
 The knowledge, skills and abilities typically acquired through the completion of a high school diploma and/or GED.
 </li>
 </ul>
 
 
 
 
 
 Preferred Education:
 
 
 <ul>
 <li>
 The knowledge, skills and abilities typically acquired through the completion of a bachelor's degree program or equivalent degree in a field of study related to the job.
 </li>
 </ul>
 
 
 
 
 
 Minimum Years of Work Experience
 
 :
 
 <ul>
 <li>
 8
 </li>
 </ul>
 
 
 
 
 
 Preferred Years of Work Experience:
 
 
 <ul>
 <li>
 10
 </li>
 </ul>
 
 
 
 
 
 Minimum Leadership Experience
 
 :
 
 <ul>
 <li>
 3+ years of previous leadership experience
 </li>
 </ul>
 
 
 
 
 
 Preferred Leadership Experience:
 
 
 <ul>
 <li>
 5+ years of previous leadership experience
 </li>
 </ul>
 
 
 
 
 
 Certifications:
 
 
 <ul>
 <li>
 Insurance licensing as required by state
 </li>
 </ul>
 
 
 
 
 
 Competencies:
 
 
 <ul>
 <li>
 Decision Quality
 </li>
 <li>
 Collaborates
 </li>
 <li>
 Drives Engagement
 </li>
 <li>
 Ensures Accountability
 </li>
 <li>
 Plans and Aligns
 </li>
 <li>
 Communicates Effectively
 </li>
 <li>
 Customer Focus
 </li>
 <li>
 Develops Talent
 </li>
 <li>
 Drives Results
 </li>
 <li>
 Manages Conflict
 </li>
 </ul>
 
 
</div>

Claims Manager

MUTUAL GROUP

<div>Department:
Claims
Job Description:
We are seeking an experienced Claims Manager to lead a team of commercial insurance claim adjusters and drive high-quality, compliant, and efficient claim handling across all lines of business, including commercial liability, construction defect, and management liability (E&amp;O, EPLI) claims. This role is ideal for a people-focused, results-driven leader who thrives in a fast-paced environment and brings strong technical expertise in litigation and reserving strategy .
As a Claims Manager, you will oversee complex claim investigations, evaluations, damage assessments, litigation strategy, and reserve adequacy . You will serve as a technical resource for the team, ensuring reserves are timely, accurate, and defensible, while aligning with company philosophy and actuarial expectations. You will also play a key role in mitigating risk, controlling loss costs, and strengthening relationships with underwriting, actuarial, legal, sales leadership, and agency partners
What You&rsquo;ll Do
Lead &amp; Develop a High-Performing Team
<ul><li>Supervise, mentor, and support commercial lines claim adjusters handling general liability, construction defect, E&amp;O, and EPLI claims.
</li><li>Provide technical leadership on complex coverage, liability, damages, litigation, and reserving issues.
</li><li>Conduct hiring, coaching, performance evaluations, and ongoing employee development, including litigation management and reserving best practices.
</li></ul>Litigation Management &amp; Risk Control
<ul><li>Oversee litigated and pre-litigation claims , including high-exposure and complex matters.
</li><li>Select, retain, and manage defense counsel; evaluate counsel performance, budgets, and billing.
</li><li>Establish litigation strategy, approve case plans, and monitor progress to ensure alignment with resolution and cost containment goals.
</li><li>Review pleadings, motions, discovery, expert reports, and evaluations.
</li><li>Evaluate settlement opportunities, attend mediations and settlement conferences, and provide settlement authority recommendations.
</li></ul>Reserving Strategy &amp; Technical Oversight
<ul><li>Serve as a technical manager for reserving , ensuring reserves are accurate, timely, and consistent with company philosophy and regulatory standards.
</li><li>Review and approve reserves on complex, litigated, and high-exposure claims.
</li><li>Guide adjusters on reserve rationale, documentation, and change management throughout the life of the claim.
</li><li>Partner with actuarial and finance teams on reserve adequacy reviews, trend analysis, and large loss discussions.
</li><li>Identify reserve trends, emerging exposures, and severity drivers, and recommend corrective actions.
</li><li>Support internal and external audits by ensuring reserving decisions are well-documented and defensible.
</li></ul>Ensure Quality, Compliance &amp; Efficiency
<ul><li>Monitor performance metrics including severity, reserve accuracy, litigation ratios, cycle time, and closure rates.
</li><li>Ensure claim handling, litigation, and reserving practices comply with state regulations, policy language, and company standards.
</li><li>Identify and implement process improvements to enhance efficiency, consistency, and customer experience.
</li></ul>Build Strong Internal &amp; External Partnerships
<ul><li>Collaborate closely with underwriting, actuarial, legal, sales leadership, and agency partners to support business objectives.
</li><li>Communicate effectively with insureds, brokers, defense counsel, mediators, and vendors.
</li><li>Represent the Claims Department with professionalism, integrity, and transparency.
</li></ul>Reporting &amp; Operational Oversight
<ul><li>Prepare and submit monthly reports summarizing team performance, litigation activity, reserve changes, and financial impact.
</li><li>Analyze loss and reserve trends within commercial liability, construction defect, and management liability lines.
</li><li>Provide strategic, data-driven recommendations to leadership to reduce volatility and improve claim outcomes.
</li></ul>What We&rsquo;re Looking For
Required Qualifications
<ul><li>3+ years of leadership experience in a commercial lines claims environment .
</li><li>Demonstrated experience managing litigated commercial liability claims and defense counsel.
</li><li>Strong technical knowledge of reserving practices , coverage analysis, litigation management, and regulatory requirements.
</li><li>Proven ability to coach and develop claims professionals on both technical and leadership skills.
</li><li>Excellent verbal, written, and negotiation skills.
</li><li>Ability to work regularly at a computer and use standard office equipment as part of daily responsibilities.
</li></ul>Preferred Qualifications
<ul><li>Direct experience managing construction defect, E&amp;O, and/or EPLI claims and litigation.
</li><li>Industry designations such as CPCU, AIC , or similar certifications.
</li><li>Experience partnering with actuarial teams on reserve reviews, large loss analysis, and trend reporting.
</li><li>Proven ability to build strong relationships with internal teams and external legal and business partners.
</li></ul>Work Arrangement:
<ul><li>Employees who live within 30 miles of the TMG home office are expected to follow a hybrid or in-office schedule. The initial training period may require additional in‑office days.
</li></ul>Pay Range:
Anticipated Hiring Range:
<ul><li>$110,000 - $140,000 annual base salary depending on experience, qualifications, and geographic location
</li></ul>Benefits:
We are proud to offer our full-time regular employees a robust benefits suite that includes:
<ul><li>Competitive base salary plus incentive plans for eligible team members
</li><li>401(K) retirement plan that includes a company match of up to 6% of your eligible salary
</li><li>Free basic life and AD&amp;D, long-term disability and short-term disability insurance
</li><li>Medical, dental and vision plans to meet your unique healthcare needs
</li><li>Wellness incentives
</li><li>Generous time off program that includes personal, holiday and volunteer paid time off
</li><li>Flexible work schedules and hybrid/remote options for eligible positions
</li><li>Educational assistance
</li></ul>Equal Opportunity Employer
The Mutual Group is an Equal Opportunity Employer. It is our policy to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
<ul><li>Know Your Rights: Workplace Discrimination is Illegal
</li><li>Your Rights Under USERRA
</li></ul>Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact Talent@themutualgroup.com .
Employment Verification
The Mutual Group participates in the E-Verify program and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. You are protected from employment discrimination based on your citizenship status and national origin.
E-Verify Program Overview 
E-Verify Participation Poster 
All offers of employment are contingent upon the successful completion of a background check.
#TMG</div>

Inner Parish Security Corporation

<div>Claims Manager 
IPSC is seeking a Risk Manager with excellent customer service and security skills to join our highly-regarded team. Pay will be determined based on skills, experience and education related to the position.
Purpose: This position is intended to help IPSC be the safest possible environment for all employees. This position will oversee the safety, risk management, and claims management aspects of the company. The Risk Manager will work with the various Depts. to train team members, and ensure policies and procedures are in the best interest of IPSC in terms of liability. This person is intended to help mitigate risk, manage claims and lawsuits, and coordinate with both internal and external parties to handle claims, settlements and investigations. This role will develop and manage all aspects of establishing a safety culture in the workday of all of our employees. IPSC will take a proactive approach to safety training, reducing accidents and provide Driver Safety incentives. 
Responsibilities:
Serve on the Risk Management Committee; Conduct weekly, monthly and quarterly review meetings
Claims Management:<ul><li>
Report Claims</li><li>
Claims Review / Management (following up)</li><li>
Working with Claim agents for various insurance companies</li><li>
Collecting claims updates from the various CP&rsquo;s.</li><li>
Investigations</li><li>
Follow-up</li><li>
Post incident procedures including discipline and training</li></ul>
Internal Investigations:<ul><li>
Reach out to involved IPSC parties &ndash; requesting additional information (pictures, videos, incident reports, check lighthouse for reports, ask for statements, request copies of post orders and or contracts)</li><li>
When necessary, communicate with other involved parties in investigations.</li></ul>
If you have a passion for providing crucial security services and seek a challenging role with an enthusiastic team, IPSC is the company for you.
Physical/Mental Requirements:<ul><li>
Ability to operate general office equipment.</li><li>
Ability to effectively communicate using verbal and written skills.</li><li>
Ability to make sound decisions.</li><li>
Prolonged periods of sitting at a desk and working with office equipment.</li><li>
Must be able to lift up to 10 pounds.</li></ul>
If you need assistance to accommodate a disability, you may request an accommodation at any time.Equal Opportunity Employer/Veterans/Disabled
#IPSCT4S</div>

Rousseau Insurance Agency

Claims ManagerReports to: Personal Lines Vice PresidentLocation: Biddeford, MEWhy UsAt Rousseau Insurance Agency, we&rsquo;re more than a workplace&mdash;we&rsquo;re a third-generation, family-owned agency that believes in meaningful work, lasting client relationships, and a healthy work-life balance. If you thrive in a collaborative, supportive environment and enjoy helping people, we want to hear from you!Why This RoleWe are seeking a Claims Manager to report directly to the Personal Lines Vice President. In this full-time role, you will lead the charge in facilitating efficient claims resolutions (80%) while providing specialized loss control support to clients (20%). This role combines problem-solving, relationship management, and real impact.In this role, you will:&middot; Guide clients through the claims process in a timely manner with empathy and expertise&middot; Advocate for clients on coverage denials, Reservation of Rights letters and high-exposure settlements&middot; Build relationships that foster client and carrier trust, loyalty, and long-term retention&middot; Partner with producers and the Commercial Lines Manager to develop tailored risk management strategies for clients&middot; Stay current on legal, regulatory and market changes that may impact claims and ability to mitigate risk&middot; Keep client records up to date in AMS360 or claims database with accurate notes and activity&middot; Provide input to the Partners on how to improve coverage language or limits based on claim outcome and emerging risks&middot; Conduct risk assessments and loss analyses&middot; Collaborate with insurance carriers on renewal negotiationsWhat We Offer&middot; Starting salary of $60,000+, depending on experience&middot; Medical, dental, and vision insurance&middot; Life and disability insurance&middot; 401(k) with employer contributions&middot; Generous PTO + paid holidays&middot; Paid volunteer time&middot; Paid continuing education &amp; bonuses for earning designations&middot; A supportive team that celebrates your success and invests in your futureWhat You Need to Bring<ul><li>Active Property &amp; Casualty Producer and/or Adjuster license (required)</li><li>Preferred credentials: CIC, AIC, CRM</li><li>Technical expertise in Property &amp; Casualty coverage lines</li><li>Experience as a Claims Manager 5+ years</li><li>Strong communication skills and negotiation skills to achieve favorable claim outcomes and influence carrier decisions on behalf of clients</li><li>Ability to thrive in a fast-paced team environment</li><li>Self-motivated with a demonstrated ability to problem solve and manage time effectively</li><li>Highly organized and detail-focused</li><li>Professional, friendly, and patient demeanor</li><li>Ability to travel occasionally for large claims and loss control meeting</li></ul>Are You Ready?If you're ready to grow your career in a place where you're supported, challenged, and appreciated&mdash;we&rsquo;d want to hear from you. To apply, email your resume to Matt Rousseau at mrousseau@rousseauinsurance.com.Rousseau Insurance Agency is an equal opportunity employer. Opportunities for employees and applicants for employment are made without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, or status as a covered veteran in accordance with applicable federal, state, and local laws.Rousseau Insurance Agency is an equal opportunity employer. We welcome applicants from all backgrounds.Pay: From $60,000.00 per yearBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Flexible schedule</li><li>Health insurance</li><li>Paid time off</li></ul>Experience:<ul><li>Property $ Casualty Claims: 5 years (Preferred)</li><li>property casualty insurance: 5 years (Required)</li></ul>License/Certification:<ul><li>Property &amp; Casualty License (Required)</li></ul>Ability to Relocate:<ul><li>Biddeford, ME 04005: Relocate before starting work (Required)</li></ul>Work Location: Hybrid remote in Biddeford, ME 04005

MetLife

<div><div><div><div><div><div>Working Schedule
</div><div>Full-Time
</div></div><div><div>Work Arrangement
</div><div>Hybrid
</div></div><div><div>Relocation Assistance Available
</div><div>No
</div></div><div><div>Posted Date
</div><div>24-Feb-2026
</div></div><div><div>Job ID
</div><div>15805
</div></div></div></div></div><div><div><div><h3 class="jobSectionHeader">Description and Requirements
</h3></div></div><div><div><div><div>Claims Manager 
</div></div><div><div> 
The Opportunity
The Claims Manager is responsible for leading a fast‑paced, high‑volume, and globally connected claims organization, ensuring operational excellence across all claims processes. Guided by our purpose &ndash; always with you building a more confident future &ndash; and our New Frontier strategy focused on stronger growth, attractive returns, and all‑weather performance, this role offers the opportunity to shape and elevate our claims operations at scale.
This is an exciting opportunity to lead a seasoned team, enhance end‑to‑end claims performance, strengthen risk and control frameworks, and drive impactful operational improvements across the organization. 
Key Responsibilities<ul><li>
Lead assessment and approval of Life, Personal Accident, and Unemployment claims within authorization limits.</li><li>
Create effective financial controls supporting daily payment verification, accuracy checks, and reconciliation processes.</li><li>
Oversee preparation and delivery of general, regional, and domestic reports, including quarterly SEDDK reporting (Table‑50 and Table‑10).</li><li>
Manage compliance with internal controls, regulatory requirements, and alignment with regional and local standards.</li><li>
Develop proactive risk mitigation practices and a strong control environment to prevent fraud.</li><li>
Coordinate team resources, operational capacity planning, leave schedules, and service continuity.</li></ul> 
Required Qualifications<ul><li>
Bachelor&rsquo;s degree from a 4‑year university (Medical professionals or graduates of Business, Economics, Engineering, or related fields preferred).</li><li>
Excellent command of English (written and verbal).</li><li>
Minimum 15 years of experience in the insurance sector with strong exposure to claims operations.</li><li>
At least 10 years of managerial/leadership experience, ideally overseeing large teams.</li><li>
Strong analytical thinking, problem‑solving, and decision‑making abilities.</li><li>
Proven crisis‑management skills and the ability to perform under pressure.</li><li>
Strong stakeholder management experience, especially in global or matrix structures.</li><li>
High attention to detail, strong sense of accountability, and process‑oriented mindset.</li><li>
Experience in process improvement, digitalization, and operational transformation is an advantage.</li></ul><ul><li> 
Preferred Qualifications</li><li>
15+ years of experience in claims operations or related functions.</li><li>
Experience with digital tools and platforms that enhance claims operational efficiency.</li><li>
Strong leadership skills with the ability to coach, motivate, and align large teams.</li><li>
Demonstrated ability to drive operational excellence and improve turnaround times.</li><li>
Customer‑centric mindset with focus on service quality and satisfaction.</li></ul>
</div></div></div></div></div><div><div><div><div><div><div>Benefits We Offer 
 
Our benefits are designed to care for your holistic well-being with programs for physical and mental health, financial wellness, and support for families.
We offer private health insurance for you and your family, life insurance, employer pension plan, meal and transportation allowance, as well as a work from home allowance. We also provide a cultural Heritage Day off, and &ldquo;back to school&rdquo; and &ldquo;school report day&rdquo; leaves and much more!</div> 
<div></div>
</div></div><div><div>About MetLife 
<div></div>
Recognized on Fortune magazine's list of the &quot;World's Most Admired Companies&quot; and Fortune World&rsquo;s 25 Best Workplaces&trade;, MetLife, through its subsidiaries and affiliates, is one of the world&rsquo;s leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East.
Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we&rsquo;re inspired to transform the next century in financial services. At MetLife, it&rsquo;s #AllTogetherPossible. Join us!</div></div></div></div></div></div>

Crawford Thomas Recruiting

<div>
 
 Salary:
 
 $95,000 &ndash; $135,000+ (negotiable) + Bonus
 
 
 
 Location:
 
 Onsite in Clearwater, FL &ndash; 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,
 
 
</div>

MagnaCare

<div>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<ul><li>
Effectively manage remote and office-based teams, promoting strong leadership and employee engagement.</li><li>
Manages a unionized staff, ensuring adherence to collective bargaining agreements while fostering a collaborative and accountable work environment.</li><li>
Provide comprehensive support for claims, appeals, internal departments, vendors, and customers.</li><li>
Daily workload distribution and monitoring for timely resolution.</li><li>
Conduct and/or support training for new hires, vendors, and existing staff.</li><li>
Staff performance monitoring and management.</li><li>
Monitor and evaluate claims performance to identify trends and areas for improvement.</li><li>
Handle escalated issues and process high-value claims and adjustments.</li><li>
Identify process improvement opportunities and establish supporting workflows.</li><li>
Review and ensure quality of claims and logic changes in the claims processing systems and applications.</li><li>
Coach employees to exceed quality and productivity standards, addressing performance issues.</li><li>
Conduct audits and manage payroll, schedules and time off requests.</li><li>
Document and address performance concerns and conduct quarterly evaluations.</li><li>
Perform focus audits, creation of ad hoc reports and result summaries for management and/or client.</li><li>
Regularly conduct individual and team meetings.</li><li>
Must be adaptable and willing to provide backup leadership support across various departments and teams as needed.</li></ul>
Essential Qualifications<ul><li>
5+ years in a leadership role&mdash;preferably claims.</li><li>
Advanced knowledge of Microsoft Office (Word and Excel).</li><li>
5+ years of advanced claims adjudication experience including facility, professional and ancillary claims is required.</li><li>
Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required.</li><li>
Strong problem solving/analysis skills.</li><li>
Organizational skills: ability to effectively prioritize and multitask.</li><li>
Ability to establish and maintain positive and effective work relationships with clients, coworkers, members, providers and customers.</li><li>
Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.</li><li>
Bachelor&rsquo;s Degree preferred or comparable experience in the healthcare field.</li><li>
Bilingual preferred.</li></ul>
At MagnaCare LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you&rsquo;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&rsquo;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&rsquo; compensation programs, we create benefit plans that address unique needs with precision.
YJ9TdzgpN2</div>

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