Manager Claims - LH

Job Summary

The 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.

Required 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 Qualifications

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

Location

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.