Claims Manager

Claims Manager Location Hybrid work in Lake Mary, FL :

Falck Global Assistance (FGA) encompasses a complete travel risk management solution and assuring safe working conditions, both medically and security-wise, for a wide range of international businesses with employees travelling or stationed abroad. FGA provides bespoke travel, health and risk management products, delivering expert driven and digitalized services focused on securing excellent end-user satisfaction with a human touch.

Position Summary: We are seeking a highly motivated and detail-oriented Manager of Claims and Cost Containment to oversee the management of claims, both U.S. domestic and international, related to travel assistance. Most of these claims will be medical assistance claims. The ideal candidate will have a strong background in medical claims management, process improvement, and team leadership.

The focus of this role includes identifying inefficiencies, working collaboratively to develop improvements (both automated and manual) and implementing those improvements. Additionally, this position will be responsible for documenting policies, procedures, workflows, and training materials to ensure operational excellence.

This is a hybrid position requiring 2 days in the office on a weekly basis.

Compensation: Competitive Package including Bonus Structure

What We Offer:

• Full-Time Benefits (Medical, Dental, Vision, Life)
• 401(k) with company match
• Training and Career Development
• Paid Time-Off

Essential Functions: Team Leadership and Collaboration

• Lead and mentor a team of claims specialists, providing guidance and support to achieve departmental goals.
• Foster a collaborative and inclusive work environment that encourages innovation and continuous improvement.
• Act as a liaison between the claims team and other departments, ensuring communication and collaboration.

Claims and Cost Containment Management

• Oversee the end-to-end claims management process for U.S. domestic and international claims invoices.
• Ensure timely and accurate processing of claims in compliance with company policies and regulatory requirements.
• Monitor cost containment strategies to minimize expenses while maintaining high-quality service delivery.
• Collaborate with internal teams and external vendors to negotiate cost savings and resolve claims disputes.

Process Improvement and Project Management

• Identify inefficiencies and areas for improvement within claims and cost containment workflows.
• Lead cross-functional projects to implement process improvements, ensuring alignment with organizational goals.
• Develop and track key performance indicators (KPIs) to measure the success of implemented changes.
• Utilize project management tools and methodologies to ensure timely delivery of initiatives.

Policy, Procedure, and Training Documentation

• Develop, update, and maintain comprehensive policies and procedures for claims and cost containment operations.
• Create detailed workflows and process maps to ensure clarity and consistency across the team.
• Design and deliver training materials to onboard new team members and upskill existing staff
• Ensure all documentation is compliant with regulatory standards and company guidelines

Qualifications:

• Minimum of 5 years of experience in a leadership role with at least 2 years of experience in claims management, cost containment, or a related field.
• Experience handling both domestic and international claims is preferred.
• Strong analytical and problem-solving skills with a focus on process improvement.
• A high degree of accuracy and attention to detail.
• Proven ability to manage multiple projects simultaneously and meet deadlines.
• Excellent written and verbal communication skills, with the ability to create clear and concise documentation.

• Self-sufficient with a high level of organizational ability.

• Ability to learn/navigate claims management software and project management tools.

• Must have a working knowledge of software programs such as Microsoft Outlook, Word, Excel, Power Point and MS Teams

Education Requirements:

Preferred: Bachelor's Degree in Business Administration, Insurance, Healthcare Management or a related field.

Travel and Location Requirements:

• Hybrid position with 2 days per week in the office.

Working Conditions:

The working conditions described below are representative of those a team member encounters while performing the essential duties and responsibilities of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities of this job.

• Small to medium office or shared work space

• Monday - Friday work week

Physical Requirements:

The physical demands described below are representative of those that must be met by a team member to successfully perform the essential duties and responsibilities of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

• Ability to sit for long periods of time

• Ability to use a computer for long periods of time

• Ability to use hands to handle, control, or feel objects, tools, or controls.

• Ability to repeat the same movements for long periods of time

Falck is an Equal Opportunity Employer (EOE). Qualified applicants are considered for employment without regard to race, color, religion, sex, gender identity, pregnancy, national origin, ancestry, citizenship, age, marital status, disability, sexual orientation, genetic information, veteran status or any other characteristic protected by state or federal law.

This is a summary of duties, it is by no means an all-inclusive list but is merely a broad guide of expected duties.