Manager Claims

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Job SummaryThe Claim Manager is responsible for the day-to-day supervision and management of a team, or multiple teams, of Luminare Health Claim Analysts and/or outsourced vendor staff enabling the department to meet its client and corporate commitments. Responsibilities include, but are not limited to, successful achievement of team quality, production and service expectations, staff development, successful implementation of new clients into the Unit, and retention of existing clients. The Manager is responsible for answering complex or difficult claim or customer service questions, advising team members regarding claim processing or customer service procedures, and providing support to ensure all department goals are met. The Manager is expected to have greater visibility and accountability than a Claim Supervisor. This may involve responsibility for multiple Claim Units, each with its own Supervisor, a Claim Unit with more complex or visible clients, and/or management of an outsourced vendor relationship.

Job Description

• Manage, monitor, track and report performance of Claim Analysts, Claim Units and/or vendor to ensure claim inventory, turnaround time, production, quality and service objectives are achieved. Assign daily work and adjust as needed based on staff availability and business need.
• Handle personnel matters including mentoring, coaching, motivating, performance management and feedback, recognition, performance evaluation and time tracking of direct reports.
• Provide input into compensation and promotion increases.
• Regularly communicate with Claim Analysts or Supervisors via unit meetings and one-on-one meetings with team members
• Mentor and develop leaders within team.
• Interview and recommend viable candidates for job openings.
• Collaborate with location/region Trainers to orient and develop new Analysts, assess new Analyst performance and training needs, timely and effectively implement new policy and procedure, and assess ongoing training needs.
• Handle claim referrals and over-authority claim audits using internal and external resources as needed. Advise Claim Analysts or vendor regarding claim processing.
• Resolve client, member, or provider issues regarding escalated or complex claims.
• Work on behalf of clients to ensure reinsurance claims are processed correctly and within appropriate filing limits to achieve maximum reimbursement.
• Interface with Client Management Team to ensure successful implementation of new clients, and retention of existing clients, from a claim & customer service perspective.
• Effectively communicate and advise staff on client benefits and unique client handling to ensure proper claim processing. Participate in or oversee User Testing to ensure benefits are set-up correctly.
• May participate in client meetings or sales presentations.
• Collaborate with regional and/or vendor staff, as well as enterprise wide leadership and peers, to develop effective policies and procedures. Ensure that policies and procedures are implemented timely and effectively.
• Participate in regional and enterprise wide work teams and projects. Include staff as needed for both their input and development.
• Other duties as needed/assigned

Required Job Qualifications:

• High School Diploma or GED equivalent
• 3-5 years claim processing experience
• Previous supervisory or management experience
• Self-directed individual who works well with minimal supervision
• Excellent verbal and written communication skills
• Strong leadership, organizational and interpersonal skills
• Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Managers and all levels of staff
• Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
• Ability to effectively deal with problems in varying situations and reach resolution
• Ability to read, analyze and interpret documents and Summary Plan Descriptions (SPDs)
• Flexible; open to continued process improvement
• Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word

Preferred Job Qualifications:

• Bachelor’s degree
• Self-Funded Insurance/Benefits and/or TPA experience

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EEO Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Pay Transparency Statement:

At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates. 

  

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Min to Max Range:

$48,500.00 - $91,000.00 Apply