Claims Manager

Job Description

Job Description

Position Overview:

Harrison Gray Search is seeking a Claims Manager to lead the Claims Department in delivering exceptional service to insurance companies, employers, and members. In this pivotal role, you will oversee claims adjudication, drive operational strategy, and ensure high accuracy and timely service per SLAs. You will manage vendor relationships, spearhead quality improvements, and foster a culture of transparency and member-focused service. With at least 5-7 years of claims operations management experience and strong leadership skills, you will shape department success through budgeting, staffing, and innovative automation strategies. If you are ready to make a meaningful impact in a dynamic third-party administration environment, this is your opportunity.

Job Title: Claims Manager

Department: Claims

Status: Exempt

Reports To: Operations Manager

Essential Duties and Responsibilities:

• Serve as a key member of the management team, demonstrating leadership through strong communication, business metrics, and a focus on continual quality improvement.
• Coordinate all activities of the Claims Department Management Team, including Supervisors and/or Team Leaders assigned to clients.
• Oversee department strategy, planning, staffing projections, budgeting, and quality assurance/improvement.
• Make final hiring decisions within the Claims Department, ensuring high standards and collaborating with Human Resources and the COO.
• Create a culture of exceptional service for members and providers, with transparency in reporting results, trends, and issues to senior management and clients.
• Manage relationships with Preferred Provider Organizations, Reference-Based Pricing vendors, and essential vendors involved in claims adjudication.
• Identify and manage Subject Matter Experts (SMEs) and backups across claims functions.
• Oversee training programs for new and existing employees.
• Maintain and update claims documentation, policies, procedures, and reference materials.
• Participate in RFP/proposal processes and prospective client presentations as requested.

Claims Department-Specific Duties:

• Contribute to product development through technical review of new products and clients.
• Ensure accurate daily reporting of claims status and workflow.
• Develop and implement automation strategies for claims processing.
• Set and monitor production requirements for Examiners.
• Establish and monitor operational controls for claims cost management.
• Continually develop and enforce policies and procedures for process consistency and quality.
• Collaborate with the Manager of Quality to implement accuracy standards and audit procedures.
• Use audit results to develop ongoing training and procedural improvements.
• Coordinate escalations and ensure timely, complete resolutions.
• Review and approve higher-dollar claims before payment.
• Oversee claims processing technology and benefit category updates.
• Act as a liaison with clients for escalations and program questions.
• Participate in formal responses to complaints, grievances, and appeals.
• Support product development and sales processes, including regulatory reviews and vendor contracting.

Performance Expectations:

• Meet or exceed budget targets for staffing and expenses.
• Achieve SLA results as measured quarterly and by client.
• Maintain high department satisfaction levels as measured by annual client surveys.
• Meet or exceed quality goals as measured by audits.

Qualifications and Competencies:

• Minimum 5-7 years in a management role for claims operations, servicing health insurance policies or benefits.
• Strong organizational, interpersonal, and motivational skills.
• Excellent written and verbal communication skills.
• Bachelors degree preferred.

Work Environment/Physical Demands:

• Office-based role with regular communication, data entry, and occasional lifting to 30 pounds. A hybrid role option after successful onboarding.

Benefits:

• Health coverage: Two flexible medical plans
• Dental & vision: Comprehensive coverage (vision is company-paid)
• Health Savings Account (HSA) and Flexible Spending Accounts (FSA)
• Company-paid life & disability insurance with optional additional coverage
• Generous PTO and paid holidays
• Employee Assistance Program (EAP)
• 401 (k) with company match after eligibility
• Frequent employee appreciation events
• Dynamic, motivating work environment with clear career paths
• Competitive compensation and strong employee retention
• Teamwork-focused culture with high visibility to senior management
• Convenient Clearwater location
• *Relocation fee to be extended for the right candidate.