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.

Why Join Us

• Flexibility: Primarily in-office role with hybrid flexibility and scheduling options that support work-life balance.
• Comprehensive Benefits: Competitive benefits package, generous Paid Time Off (PTO), and paid holidays from day one.
• Continual Learning and Growth: Collaborative, education-focused environment that encourages skill development and career growth.
• Leadership Impact: Coach team members, improve processes, and create a positive experience for clients and partners.
• Annual Bonus Program: Performance-based bonus program designed to reward achievement and shared success.

Learn more about us at Amwins.com/benefits.

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: Provide regular feedback, accountability conversations, training, and technical coaching. Partner with the Claims Lead to offer targeted coaching and process guidance.
• Quality Assurance Partnership: Collaborate with the Claims Quality team to use audit findings for team development, performance management, and operational oversight. Review QA reports to monitor team-level quality trends and escalate 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 members on 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 ensure 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 effective client service.
• Training Partnership: Partner with Claims Trainer(s) to identify skill gaps, coordinate training programs, and support team member development.
• Ad Hoc: Perform 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.
  • Strong time management, prioritization, and ability to meet deadlines.
  • Excellent collaboration and teamwork skills.
  • Strong organizational and multitasking abilities.
  • Clear, professional, and thoughtful communication with internal and external partners.
  • Strong attention to detail, follow-through, and sense of urgency.
  • Supportive, solutions-oriented leadership style with a commitment to team and business success.

Benefits

• Competitive benefits package
• Generous Paid Time Off (PTO) and paid holidays
• Performance-based annual bonus program

Schedule

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