About The Role The Claims Manager provides coaching, mentoring and training of Claims Examiners while promoting quality results. The manager is responsible for identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team. Provides on-going feedback to the team and identifies areas for improvement and growth. Must be able to make independent decisions, prioritize workload effectively and collaborate with other internal departments to assist in meeting our corporate goals.
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
Primary Responsibilities
Effectively manage remote teams, promoting strong leadership and employee engagement.
Provide comprehensive support for claims, appeals, internal departments, vendors, and customers.
Daily workload distribution and monitoring for timely resolution.
Conduct training for new hires, vendors, and existing staff.
Handle escalated issues and process high-value claims and adjustments.
Identify process improvement opportunities and establish supporting workflows.
Review and ensure quality of claims and logic changes in Impact.
Support Customer Service, Client Services, and respond to inquiries.
Coach employees to exceed quality and productivity standards, addressing performance issues.
Conduct audits and manage payroll, schedules, and time off requests.
Document and address performance concerns, conducting quarterly evaluations.
Regularly conduct individual and team meetings.
Essential Qualifications
5+ years in a leadership role—preferrably claims
Advanced knowledge of Microsoft Word and Excel.
5+ years of advanced claims adjudication experience including facility, professional and ancillary claims.
Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required.
Strong problem solving/analysis skills.
Organizational skills; ability to effectively prioritize and multitask.
Ability to establish and maintain positive and effective work relationships with clients, coworkers, members, providers and customers.
Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
Bachelor’s Degree preferred or comparable experience in the healthcare field.
About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’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’ll be encouraged to bring your authentic self to work with all your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions. Come be a part of the Brightest Ideas in Healthcare™.
Company Mission Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.
Company Vision Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
DEI Purpose Statement At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.
*We are an Equal Opportunity Employer
Annual Salary Range: $85,000 - $95,000 The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Hospitals and Health Care
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