Medical Claims Manager

Amwins Self-Funded is seeking a Claims Manager to lead and support a dedicated claims team, strengthen day-to-day operations, and deliver exceptional service to clients and partners. This role is primarily in-office, with the opportunity to work from home up to two days per week after completing training.

About Us

At Amwins, we believe people do their best work when they feel supported, valued, and empowered to grow. We offer a workplace where team members can build strong relationships, contribute ideas, and make a meaningful impact.

Benefits

• Flexibility: Primarily in-office role with hybrid flexibility and scheduling options that support balance.
• Comprehensive Benefits: Competitive benefits package, generous Paid Time Off (PTO), and paid holidays.
• Continual Learning and Growth: Collaborative, education-focused environment that encourages learning, development, and career growth.
• Leadership Impact: Opportunity to lead with purpose by coaching team members, improving processes, and enhancing client experiences.
• Annual Bonus Program: Performance-based bonus program designed to reward achievement and shared success.

Responsibilities

• Team Leadership: Lead day-to-day operations and support the success of assigned Claims team members, including staffing recommendations, promotions, performance evaluations, and disciplinary actions.
• Performance Management: Support team member performance through regular feedback, accountability conversations, training, and technical coaching. Partner with the Claims Lead to provide targeted coaching and process guidance.
• Quality Assurance Partnership: Partner with the Claims Quality team to use centralized audit findings for team development, performance management, and operational oversight. Review QA reports to monitor team-level quality trends and request escalated audit coverage as needed.
• Document Management: Oversee the master list of groups/cases for the Claims Department, including all contractual claims service parameters.
• Workload Distribution: Manage client account assignments based on team and individual workload volume.
• File Management: Oversee the filing process for Stop Loss Claims within the Claims Department.
• Subject Matter Expertise: Serve as a trusted resource on complex claim submissions, providing oversight and support for high-priority claims. Guide team claim submissions, correspondence, and processes.
• Claim Tracking: Conduct claim reviews and process reimbursement filing and reporting to Stop Loss carriers as needed.
• Claim Reporting: Manage and produce monthly claims reporting and notifications to Stop Loss carriers.
• Process Improvement: Support the development and implementation of policies, procedures, and process improvements to strengthen Claims operations.
• Service Delivery: Collaborate with the Director of Claims to support consistent, high-quality service delivery for clients.
• Relationship Building: Build positive, collaborative relationships with internal departments, team members, carriers, brokers/consultants, and administrators to support responsive and effective client service.
• Training Partnership: Partner with Claims Trainer(s) to identify skill gaps, coordinate training programs, and support team member participation and development.
• Ad Hoc: Other duties and projects as assigned.

Requirements

• Required Qualifications:
  • 2+ years of management experience with a passion for leading, coaching, and developing others.
• Preferred Qualifications:
  • Bachelor's degree or 3–5+ years of experience working in Group Benefits.
  • 3–5 years of claims or production-environment experience.
• Skills:
  • Proficient in Microsoft Office programs, including Excel, Outlook, SharePoint, and Teams.
  • Proven ability to manage time effectively, prioritize workload, and meet deadlines.
  • Strong team skills and ability to work cooperatively and respectfully with staff and business partners.
  • Strong organizational and multitasking skills.
  • Ability to communicate clearly, professionally, and thoughtfully with internal and external partners.
  • Strong attention to detail, follow-through, and a demonstrated sense of urgency.
  • Supportive, solutions-oriented leadership style with a commitment to helping the team and business succeed.

Schedule

Primarily in-office, with the opportunity to work from home up to two days per week after completing training.