claims manager

Ruppert Landscape

<div>CLAIMS MANAGER
Who We Are
Ruppert Landscape is a leading provider of commercial landscape maintenance and installation services with more than 3,500 employees serving customers from 55+ branches across the Northeast, Mid-Atlantic, and Southeastern US. We take pride in delivering reliable, high-quality services on a wide range of commercial properties and construction projects. For over 50 years, our mission has been to provide opportunities for our people, take care of our customers, and be good stewards of the environment and our community.
Where You Fit In
As a Claims Manager, you will be responsible for overseeing and managing all company insurance claims, including workers&rsquo; compensation, auto liability, general liability, and property damage claims. This role is all about managing incident documentation and reporting, supporting operation teams&rsquo; adherence to a safety-first mindset, and managing relationships with outside vendors and representatives.
Responsibilities:<ul><li>
Manage all workers&rsquo; compensation, auto, general liability, and property damage claims from initial report through closure</li><li>
Review incident reports, gather documentation, and ensure timely claim reporting to insurance carriers and third-party administrators</li><li>
Coordinate with branch managers, branch safety reps, and the corporate safety team regarding claim status and return-to-work processes</li><li>
Monitor claim reserves, track open claims, and work with carriers to reduce overall claim costs</li><li>
Communicate regularly with shop managers to coordinate and track vehicle estimates and repairs</li><li>
Manage relationships with insurance carriers, adjusters, medical providers, and legal representatives</li><li>
Process all workers&rsquo; compensation invoices and insurance carrier invoices</li><li>
Maintain a deductible log for each claim and process internal branch deductibles as needed</li><li>
Conduct a monthly open claims meeting with branch and region management</li><li>
Maintain accurate claim records and documentation</li></ul> 
Qualifications:<ul><li>
Bachelor&rsquo;s degree in risk management, business, human resources, safety, or related field preferred</li><li>
Minimum of three years of experience in claims management, risk management, insurance, or safety</li><li>
Experience in landscaping, construction, transportation, or other field-service industries strongly preferred</li><li>
Knowledge of workers&rsquo; compensation, auto liability, and general liability claims processes</li><li>
Strong interpersonal and communication skills with demonstrated success in building and maintaining positive relationships with service-oriented customers and/or team members
</li><li>Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, and reporting tools</li><li>
Ability to manage multiple priorities and meet deadlines in a fast-paced environment</li><li>
Working knowledge of Occupational Safety and Health Administration (OSHA) regulations and safe workplace practices, with the ability to promote and maintain compliance in daily operations</li></ul> 
Reports To: Director of Safety &amp; Risk 
What We Offer<ul><li>
Competitive compensation package based on experience and qualifications</li><li>
Hands-on learning from day one with ongoing opportunities to learn, grow, and build your career</li><li>
Paid time off and holidays to help you maintain a healthy work-life balance
</li><li>Medical, dental, and vision insurance plans, plus flexible spending accounts (FSAs) to help cover healthcare and dependent care expenses</li><li>
401(k) retirement savings plan with company match</li><li>
Employee Assistance Program (EAP) with confidential support for personal, financial, and wellness needs</li><li>
A people-first, family-oriented culture where teamwork, respect, and growth matter and where your hard work is recognized and appreciated</li></ul> 
Why Ruppert
Our success starts with our people. We are committed to creating opportunities for our team members to grow, lead, and build meaningful careers. Through hands-on training, strong mentorship, and a collaborative team environment, we invest in developing talented individuals who take pride in their work and in supporting one another. Guided by our core values, we are dedicated to doing the right thing for our employees, our customers, and our communities. From maintaining safe work sites to promoting environmental stewardship, we strive to make a positive, lasting impact everywhere we work.
Ruppert Landscape is an Equal Opportunity and E-Verify Employer.
This job description is subject to change at any time.</div>

Claims Manager

Bitco Insurance Companies

<div>BITCO is seeking a Claims Manager- General Liability to join our branch office located in Denver CO. As a respected specialty insurer with 11 branch offices across 10 states, BITCO delivers tailored insurance solutions to complex industries such as construction, forest products, and oil and gas.

This position is open to a hybrid work arrangement, blending flexibility with meaningful in-person collaboration. Candidates should be comfortable with occasional business travel to other BITCO offices and offsite locations.

At BITCO, our work is guided by core values. We care deeply about our people, partners, and customers. We are committed to excellence and accountability. We deliver on our promises with integrity and precision, and we strive to make a meaningful impact in everything we do. These values drive our mission to protect the people and industries that keep America running.

Join the BITCO team and be part of a workplace built on collaboration, open communication, and a positive culture that supports growth and success. If you are passionate about operational excellence and ready to make a measurable impact within a growing, industry-leading organization, BITCO offers the platform and challenge you have been looking for

Position Summary:

As a General Liability Claims Manager, you will lead the day-to-day operations of the claims team within the assigned branch office. In this role, you will oversee workflow distribution, coach and develop team members, and ensure claims are handled accurately, efficiently, and within established timelines. You will play a critical role in driving service excellence, supporting team performance, and maintaining compliance with company policies, procedures, and regulatory standards.

Primary Responsibilities:
<ul>
<li>Directs and supervises the work of assigned claims team, including the quality, quantity and timeliness of work product</li>
<li>Maintains current company and department processes and procedures. Assigns work, provides training and feedback to team members, and conducts timely and appropriate evaluations of job performance in the department</li>
<li>Supervises and participates in the functions of the assigned claims team to meet the needs of internal and external customers</li>
<li>Review, analyze, and interpret policy conditions, exclusions and endorsements to resolve coverage and liability issues for assigned claims</li>
<li>Review and evaluate claim reserves to ensure that the respective reserve properly reflects the potential exposure</li>
<li>Review and evaluate contractual documents to identify potential risk transfer opportunities or exposure</li>
<li>Investigate claims to evaluate coverage and legal issues, and obtaining statements, records, and other evidentiary materials</li>
<li>Provide proper documentation and reporting of investigation and claims handling activities</li>
<li>Negotiates, settles, and resolves claims with claimants and insureds; provides appropriate claims resolution documents</li>
<li>Maintain a working knowledge of regulatory and jurisdictional requirements</li>
<li>Provides direction to and management of independent adjusters and other third parties retained to assist in a particular claim</li>
<li>Coordinates with claims management to staff assigned claims team with persons who have the appropriate skills, abilities and interests to perform the job responsibilities</li>
<li>Coordinates with and assists claims management in carrying out personnel and salary administration involving persons under their supervision.</li>
<li>Participates with the Underwriting management team on preparing and carrying out the office's business plan each year, including setting of business objectives with revisions and modifications as needed to meet the branch sales and profit goals</li>
<li>Provides training for local claims team</li>
<li>Coordinates with the Underwriting management team in preparing or giving input for the preparation of required budgets for the branch office</li>
<li>As a management representative, consistently acts in the best interest of BITCO and provides leadership and communication to actively promote BITCO's mission, core values, and culture</li>
<li>Perform other duties as assigned</li>
</ul>
Qualifications:
<ul><li>Five or more years' experience handling multi-line commercial claims preferred</li>
<li>Prior supervisory or management experience preferred</li>
<li>Strong knowledge of coverage, negligence principles, investigation, and negotiation techniques</li>
<li>Strong knowledge and understanding of contractual risk transfer principals (upstream and downstream)</li>
<li>Must be service-oriented, with the ability to provide prompt, efficient, and effective claims and customer service</li>
<li>Strong verbal and written communication skills, both internally within the team and externally</li>
<li>Proven ability to stay organized and meet deadlines</li>
<li>Ability to accurately organize, prioritize and complete all job responsibilities, without supervision and within assigned deadlines</li>
<li>Efficiently utilize and oversee the utilization of computers and claims related software, and other office machines/equipment, to perform job responsibilities and those of the persons being supervised</li>
<li>Licensed and/or ability to be licensed in the states requiring adjuster licensing</li>
</ul>
Salary Range: $110,000.00- 180,000.00, commensurate with experience.

Benefits:

<ul><li>Competitive salary paired with a comprehensive benefits package</li>
<li>Generous paid time off, plus 12 paid holidays annually</li>
<li>Comprehensive health coverage, including medical, dental, and vision plans</li>
<li>Additional protection through accident, critical illness, and hospital indemnity insurance</li>
<li>Company-paid life insurance equal to 2&times; annual salary</li>
<li>Company-paid short-term and long-term disability coverage</li>
<li>401(k) Savings and Profit-Sharing Plan through Old Republic</li>
<li>Ongoing education, training, and professional development opportunities</li>
<li>Support for industry certifications and insurance designations, including financial assistance</li>
<li>Flexible scheduling with a two-hour window for start and end times within a 7.5-hour workday</li>
<li>Opportunities to give back through corporate philanthropy and community service initiatives</li>
<li>Optional benefits including travel, commuter, and pet insurance</li>
<li>Employee wellness support through a dedicated fitness program</li></ul></div>

Claims Manager- General Liability

<div>BITCO is seeking a Claims Manager- Workers' Compensation to join our regional office located in Pasadena, CA. As a respected specialty insurer with 11 branch offices across 10 states, BITCO delivers tailored insurance solutions to complex industries such as construction, forest products, and oil and gas.

This position is open to a hybrid work arrangement, blending flexibility with meaningful in-person collaboration. Candidates should be comfortable with occasional business travel to other BITCO offices and offsite locations.

At BITCO, our work is guided by core values. We care deeply about our people, partners, and customers. We are committed to excellence and accountability. We deliver on our promises with integrity and precision, and we strive to make a meaningful impact in everything we do. These values drive our mission to protect the people and industries that keep America running.

Join the BITCO team and be part of a workplace built on collaboration, open communication, and a positive culture that supports growth and success. If you are passionate about operational excellence and ready to make a measurable impact within a growing, industry-leading organization, BITCO offers the platform and challenge you have been looking for

Position Summary:

As a Workers' Compensation Claims Manager, you will lead the day-to-day operations of the claims team within the assigned branch office. In this role, you will oversee workflow distribution, coach and develop team members, and ensure claims are handled accurately, efficiently, and within established timelines. Ensure that all claim files are reserved accurately and appropriate for exposure. You will play a critical role in driving service excellence, supporting team performance, and maintaining compliance with company policies, procedures, and regulatory standards.

Primary Responsibilities:
<ul>
<li>Directs and supervises the work of assigned claims team, including the quality, quantity and timeliness of work product</li>
<li>Maintains current company and department processes and procedures. Assigns work, provides training and feedback to team members, and conducts timely and appropriate evaluations of job performance in the department</li>
<li>Supervises and participates in the functions of the assigned claims team to meet the needs of internal and external customers</li>
<li>Review, analyze, and interpret policy conditions, exclusions coverage issues for assigned claims</li>
<li>Review and evaluate claim reserves to ensure that the respective reserve properly reflects the potential exposure</li>
<li>Review and evaluate contractual documents to identify potential subrogation and apportionment opportunities</li>
<li>Investigate claims to evaluate coverage and legal issues, and obtaining statements, records, and other evidentiary materials</li>
<li>Provide proper documentation and reporting of investigation and claims handling activities</li>
<li>Negotiates, settles, and resolves claims with claimants and insureds; provides appropriate claims resolution documents</li>
<li>Maintain a working knowledge of regulatory and jurisdictional requirements</li>
<li>Provides direction to and management of independent adjusters and other third parties retained to assist in a particular claim</li>
<li>Coordinates with claims management to staff assigned claims team with persons who have the appropriate skills, abilities and interests to perform the job responsibilities</li>
<li>Coordinates with and assists claims management in carrying out personnel and salary administration involving persons under their supervision.
</li><li>Participates with the Underwriting management team on preparing and carrying out the office's business plan each year, including setting of business objectives with revisions and modifications as needed to meet the branch sales and profit goals</li>
<li>Provides training for local claims team</li>
<li>Coordinates with the Underwriting management team in preparing or giving input for the preparation of required budgets for the branch office</li>
<li>As a management representative, consistently acts in the best interest of BITCO and provides leadership and communication to actively promote BITCO's mission, core values, and culture</li>
<li>Perform other duties as assigned
</li></ul>Qualifications:
<ul><li>Five or more years' experience handling multi-line commercial claims preferred</li>
<li>Prior supervisory or management experience preferred</li>
<li>Strong knowledge of WC coverage, Subrogation principles, investigation, and negotiation techniques</li>
<li>Must be service-oriented, with the ability to provide prompt, efficient, and effective claims and customer service</li>
<li>Strong verbal and written communication skills, both internally within the team and externally
</li><li>Proven ability to stay organized and meet deadlines
</li><li>Ability to accurately organize, prioritize and complete all job responsibilities, without supervision and within assigned deadlines</li>
<li>Efficiently utilize and oversee the utilization of computers and claims related software, and other office machines/equipment, to perform job responsibilities and those of the persons being supervised</li>
<li>Licensed and/or ability to be licensed in the states requiring adjuster licensing</li>
<li>Strong CA Workers' Compensation technical claim knowledge.</li>
</ul>
Salary Range: $110,000.00- 180,000.00, commensurate with experience.

Benefits:
<ul><li>Competitive salary paired with a comprehensive benefits package</li>
<li>Generous paid time off, plus 12 paid holidays annually</li>
<li>Comprehensive health coverage, including medical, dental, and vision plans</li>
<li>Additional protection through accident, critical illness, and hospital indemnity insurance</li>
<li>Company-paid life insurance equal to 2&times; annual salary</li>
<li>Company-paid short-term and long-term disability coverage</li>
<li>401(k) Savings and Profit-Sharing Plan through Old Republic</li>
<li>Ongoing education, training, and professional development opportunities</li>
<li>Support for industry certifications and insurance designations, including financial assistance</li>
<li>Flexible scheduling with a two-hour window for start and end times within a 7.5-hour workday</li>
<li>Opportunities to give back through corporate philanthropy and community service initiatives</li>
<li>Optional benefits including travel, commuter, and pet insurance</li>
<li>Employee wellness support through a dedicated fitness program</li></ul></div>

Claims Manager- Worker's Compensation

CNA Insurance

<div>You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
Under general direction manages a team of claims professionals for a specific line of business. Responsibilities include overseeing all claim resolution activities of the team to ensure accurate and timely disposition of claims in accordance with company protocols. This position works within broad authority limits and is accountable for implementing company initiatives and driving overall team results.
JOB DESCRIPTION:
Essential Duties &amp; Responsibilities:
Performs a combination of duties in accordance with departmental guidelines:<ul><li>
Oversees the work activities of a team of claims professionals and has full management responsibility by setting and communicating expectations, providing direction and coaching, facilitating training and development, managing employee performance, and contributing to employee engagement.</li><li>
Contributes to the achievement of business results by ensuring that claims are effectively handled according to company protocols, quality and customer service standards are achieved, and expenses are appropriately managed.</li><li>
Contributes to achievement of customer satisfaction targets by ensuring quality, service and cycle time standards are met or exceeded by the team and handling escalated customer service issues promptly and professionally.</li><li>
Ensures established claim handling protocols are followed by maintaining appropriate file engagement, monitoring quality dashboards and partnering with quality assurance resources to provide meaningful technical guidance that contributes to both claim resolution strategies and employee development.
</li><li>Recognizes trends and implements improvement opportunities by monitoring team performance, reviewing and interpreting data analytics and developing strategies to improve quality, customer satisfaction and overall claim outcomes.</li><li>
Contributes to achievement of department budget and effectively manages expenses associated with claims resolution by ensuring appropriate usage of vendors, and holding team accountable to productivity and timely disposition standards.</li><li>
Builds and maintains collaborative relationships with internal and external work partners by participating in round table discussions, working with claims operations and coverage resources, providing insights to underwriters, partnering with SIU and Recovery Services and interacting with external customers, brokers and vendors as appropriate.</li><li>
Communicates and shares pertinent and timely information to employees by holding team meetings, scheduling regular 1:1 employee discussions, reinforcing leadership messages and providing shared access to company process and protocol documentation.</li><li>
Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.</li><li>
May participate in or lead project teams.</li></ul>
May perform additional duties as assigned.
Reporting Relationship
Typically Director or above
Skills, Knowledge &amp; Abilities<ul><li>
Knowledge of the insurance industry and general knowledge of the organization's products, policies and procedures.</li><li>
Ability to effectively identify, lead, coach, engage, develop and retain talented claim professionals.</li><li>
Strong claims resolution skills and knowledge of insurance and claims principles, practices and procedures for area of responsibility.</li><li>
Strong analytical and problem solving skills, with the ability to prioritize and effectively manage multiple priorities.</li><li>
Ability to effectively collaborate with internal and external business partners.</li><li>
Excellent communication skills and customer service experience, with developing ability to succinctly present to senior management.</li><li>
Ability to utilize data and analytics to measure business results and drive continuous improvements.</li><li>
Ability to manage ambiguous situations and business issues.</li><li>
Ability to embrace change and value diverse ideas and opinions.</li><li>
Knowledge of Microsoft Office Suite and other business-related software.</li><li>
Ability to model CNA's leadership behaviors.
</li></ul>Education &amp; Experience:<ul><li>
Bachelor's degree or equivalent experience.</li><li>
Typically a minimum of seven years of related work experience.</li><li>
Previous management experience is preferred</li><li>
Applicable certifications or professional designations preferred.</li></ul>
#LI-AR1
#LI-Hybrid
In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $72,000 to $141,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees &ndash; and their family members &ndash; achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA&rsquo;s benefits, please visit cnabenefits.com.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact leaveadministration@cna.com.</div>

Workers Compensation Claims Manager, East

Summit Construction & Restoration

Pay: $80,000.00 - $140,000.00 per yearJob description:Core Claims Project Manager Summit Restoration &ndash; Leesburg, VAAbout Us: Summit is seeking a Core Claims Project Manager (CCPM) to join our team. This position combines customer-facing communication, insurance claim coordination, detailed estimating (Xactimate), subcontractor management, and project oversight.You will serve as the primary point of contact for homeowners, insurance adjusters, estimate reviewers, and internal team members, ensuring projects are accurately scoped, efficiently executed, and delivered to a high standard of quality. If you have construction or restoration experience, love helping people through challenging situations, and enjoy running projects from start to finish, let&rsquo;s talk!Key Responsibilities<ul><li>Manage restoration projects (water, fire, &amp; storm repairs) from assignment to close-out.</li><li>Coordinate schedules, materials, subcontractors, and/or in-house crews to ensure timely and efficient production.</li><li>Perform jobsite walkthroughs and progress checks to ensure safety, quality, and customer satisfaction.</li><li>Maintain accurate project documentation, photos, and communication notes.</li><li>Provide proactive updates to customers, adjusters, and internal leadership to ensure transparency and trust.</li><li>Write detailed, accurate estimates in Xactimate following carrier guidelines and program requirements.</li><li>Issue production budgets and work orders based on approved estimates.</li><li>Communicate with insurance adjusters regarding approvals, supplements, depreciation, and job progress.</li><li>Resolve customer concerns quickly and diplomatically.</li></ul>Required Qualifications<ul><li>Working knowledge of residential construction methods, materials, and trades.</li><li>Ability to manage multiple jobs simultaneously in a fast-paced environment.</li><li>Excellent communication, organization, and customer-service skills.</li><li>Valid driver&rsquo;s license and ability to visit job sites across Northern Virginia.</li><li>Strong technology skills</li></ul>Preferred Qualifications<ul><li>Proficiency in Xactimate preferred, or willingness to train.</li><li>1+ years of experience in restoration project management, insurance repair, construction management, or similar field.</li><li>Experience with insurance vendor programs (Alacrity, Contractor Connection, etc.)</li><li>IICRC certifications (WRT, FSRT, ASD, AMRT, OCT, etc.)</li><li>Background managing or coordinating subcontractors</li></ul>Compensation &amp; Benefits<ul><li>Competitive base salary</li><li>Commission/bonus structure based on job profitability</li><li>Company vehicle</li><li>Unlimited PTO</li><li>Growth &amp; leadership opportunities within an expanding business</li><li>Health insurance</li></ul>Pay: $80,000.00 - $140,000.00 per yearBenefits:<ul><li>Health insurance</li><li>Paid time off</li></ul>Work Location: In person

Core Claims Project Manager

Hamlin & Burton Liability Management, Inc.

General Description:Seeking Litigation Manager to manage medical professional (high concentration of long term care) and general liability claims of moderate to high severity in compliance with company standards and industry best practices to ensure service excellence. Strongly prefer attorney who has experience in the defense of liability claims on behalf of long term care facilities.Position&rsquo;s Functions and Responsibilities:<ul><li>Must have long term care professional liability claim handling experience</li><li>Review and analyze policy coverage, including drafting of coverage denials and reservation of rights letters</li><li>Establish timely and accurate expense and indemnity reserves</li><li>Investigate and evaluate liability and damages</li><li>Conduct witness interviews, inclusive of on-site visits</li><li>Identify, obtain, and analyze documentation including, but not limited to, medical records, medical bills, contracts, photos, state health surveys</li><li>Retain experts as indicated</li><li>Determine and opine evaluations of liability, damages, settlement values, verdict ranges and percent chance to win</li><li>Coordinate and manage litigation</li><li>Manage defense counsel</li><li>Develop and implement a litigation plan of action</li><li>Establish and maintain litigation budget</li><li>Review, analyze and process vendor invoices</li><li>Prepare comprehensive reports</li><li>Claims Committee/Client presentations</li></ul>Experience and Education Requirements:<ul><li>Juris Doctor degree strongly preferred</li><li>Bachelor&rsquo;s Degree or equivalent work experience</li><li>Medical malpractice, long term care and general liability claims handling experience, or related field experience (minimum of 10 years)</li><li>Claims Adjuster license preferred</li></ul>Skills and Knowledge:<ul><li>Strong knowledge of the legal environment and litigation process</li><li>Knowledge of insurance industry compliance requirements</li><li>Strong analytical and decision-making skills</li><li>Strong negotiation skills</li><li>Strong communication skills, both written and verbal</li><li>Demonstrate ownership attitude and client-centric response to all tasks</li><li>Organizational and time management skills</li><li>Working knowledge of Microsoft Office applications (Word, Excel &amp; Outlook)</li></ul>Work Environment:<ul><li>Home office (work from home)</li><li>Travel as required to conduct on-site investigations and attend mediations, arbitrations, trials and client meetings</li><li>Professional appearance and demeanor</li></ul>Pay Transparency: The base salary for this full-time position is $155,000 plus bonus potential and benefits including generous PTO, health/dental/vision/life insurance, and a retirement savings account with company match/contribution.Job Type: Full-timePay: $155,000.00 per yearBenefits:<ul><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li><li>Work from home</li></ul>Experience:<ul><li>Medical Malpractice: 5 years (Required)</li></ul>Work Location: Remote

Attorney / Claims Adjuster

CenterWell

<div><h1 class="jobSectionHeader">Become a part of our caring community 
</h1>
The Manager, Claims Processing reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Manager, Claims Processing works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
The Manager, Claims Processing is responsible for leading and overseeing the end-to-end claims adjudication and processing function for a TPA organization. This role manages professional and/or supervisory-level associates and ensures timely, accurate, and compliant processing of complex and specialty home health, DME, home infusion and SNF claims submitted via electronic and paper formats. The Manager applies advanced technical and regulatory knowledge of Medicare, Medicaid, and commercial payers to resolve moderately complex claims issues, optimize workflows, and improve departmental performance. Responsibilities are executed within established policies and practices, with a planning horizon of less than 24 months.
Key Responsibilities
Claims Operations &amp; Adjudication<ul><li>
Oversee the review, adjudication, and resolution of home health, DME, home infusion and SNF claims, including Medicare, Medicaid, and commercial payer claims, ensuring compliance with payer guidelines, CMS regulations, and organizational policies.</li><li>
Determine whether claims are paid, denied, returned, or adjusted based on clinical documentation, coding accuracy, authorization status, and payer requirements.</li><li>
Manage escalated, complex, or high-risk claims issues, including denials, underpayments, and payer disputes.</li></ul>
Leadership &amp; People Management
<ul><li>Manage and develop claims processing professionals and/or claims supervisors; set performance expectations, provide coaching, and conduct performance reviews.</li><li>
Coordinate team activities to ensure department goals, productivity metrics, accuracy standards, and service-level agreements are met.</li><li>
Identify staffing, training, and resource needs; make tactical decisions related to workload distribution and prioritization.</li></ul>
Process Improvement &amp; Decision Making<ul><li>
Identify, lead, and implement change initiatives to improve claims processing efficiency, denial rates, turnaround times, and cash flow.</li><li>
Analyze claims trends, denial patterns, and payer policies; partner with Revenue Cycle, Clinical, Compliance, and Authorization teams to address root causes.</li><li>
Use advanced analysis and independent judgment to solve moderately complex operational and technical problems within established policies.</li></ul>
Cross-Functional Collaboration<ul><li>
Collaborate with Coding, Clinical Operations, Intake, Authorization, Finance, and Compliance teams to ensure accurate documentation and clean claim submission.</li><li>
Maintain frequent contact with peer managers and senior professionals across departments to align on workflows, regulatory updates, and payer changes.</li><li>
Participate in cross-department meetings, briefings, and audits related to billing and claims performance.</li></ul>
Compliance, Reporting &amp; Oversight<ul><li>
Ensure adherence to Medicare Conditions of Participation (CoPs), CMS Claims Processing Manual guidance, HIPAA, and payer-specific rules.</li><li>
Support internal and external audits by maintaining accurate documentation and providing claims data and analyses as requested.</li><li>
Monitor KPIs such as days in A/P, first-pass yield, denial rates, and rework volume; report results to department leadership.</li></ul>
Autonomy, Decision Making &amp; Impact (M2 Alignment)<ul><li>
Exercises independent judgment within defined policies to determine operational approaches, resource allocation, and workflow priorities for the claims team.</li><li>
Decisions have a moderate impact on departmental performance, revenue cycle outcomes, and payer compliance.</li><li>
Works with a planning horizon of up to 24 months, focusing on continuous improvement and operational stability.</li><li>
Holds significant influence over claims processing operations and contributes to broader revenue cycle effectiveness.</li></ul>
Work Complexity &amp; Knowledge<ul><li>
Applies in-depth knowledge of home health, DME, home infusion and SNF billing, claims adjudication, reimbursement methodologies, and payer regulations.</li><li>
Solves moderately complex claims and operational issues using advanced technical expertise, analytical skills, and cross-functional collaboration.</li><li>
Communicates effectively with internal stakeholders and external payer representatives to resolve issues and drive outcomes.</li></ul><h1 class="jobSectionHeader"> 
Use your skills to make an impact 

</h1>Required Qualifications<ul><li>
Bachelor&rsquo;s degree in Healthcare Administration, Business, Finance, or a related field, or equivalent combination of education and experience.</li><li>
5+ years of progressive experience in claims processing, billing, or revenue cycle management within home health, DME, home infusion, SNF or related healthcare settings.</li><li>
2 or more years of people management experience</li><li>
Comprehensive knowledge of all Microsoft Office applications, including Word, Project and Visio</li><li>
Strong working knowledge of Medicare, Medicaid, and commercial insurance reimbursement, EDI claims, and healthcare billing systems</li><li>
Must be passionate about contributing to an organization focused on continuously improving consumer experiences</li></ul>
Preferred Qualifications<ul><li>
Project Management experience</li><li>
Six Sigma certification</li></ul>
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. 

$78,400 - $107,800 per year 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.<h1 class="jobSectionHeader"> 
About Us 
</h1>
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient&rsquo;s well-being.
About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com. 
 
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.</div>

Manager, Claims Processing

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