Manager, Claims Management The (USA) Manager, Claims Management oversees the evaluation and resolution of claim disputes, ensuring compliance with regulatory and company standards. This role leads quality assurance initiatives to enhance claims handling processes and manages third-party billing requirements to optimize accuracy and efficiency. By analyzing claims data and collaborating with internal and external partners, the manager drives continuous improvement in claims operations. Additionally, this position provides leadership and development for associates, fosters strong stakeholder relationships, and upholds the highest standards of integrity and ethical conduct in all claims management activities. The Claims Management team is committed to delivering exceptional claims oversight through quality assurance, compliance, and continuous process improvement. Collaborating closely with internal leaders, legal counsel, and external partners, the team ensures claims are managed efficiently and in accordance with regulatory and company standards. Utilizing data-driven insights and innovative approaches, the team focuses on reducing risk, enhancing outcomes, and improving experiences for associates and stakeholders. This team combines operational excellence with collaborative leadership and a strong commitment to talent development, driving meaningful business impact and maintaining high standards in claims resolution and risk management.
What you'll do:
Oversee claim disputes by evaluating claim files and coordinating with independent adjusters and experts to determine claim validity and resolution.
Manage quality assurance audits to enhance claims handling procedures, analyze trends, and develop improvements for consistency and compliance.
Implement and monitor third-party billing requirements, ensuring accuracy and alignment with regulatory and industry standards.
Minimize legal exposure by collaborating with outside counsel, participating in arbitrations, and structuring complex settlements.
Drive continuous improvement by analyzing claims data, refining processes, and collaborating with internal and external partners.
Lead and develop associates through training, mentoring, and performance management to build a high-performing team.
What you'll bring:
Proven experience in claims resolution, including evaluating claim validity and managing dispute processes.
Strong knowledge of quality assurance practices to enhance claims handling consistency and compliance.
Expertise in risk management and minimizing legal exposure through collaboration with legal counsel and structured settlements.
Ability to interpret and implement third-party billing requirements ensuring accuracy and regulatory compliance.
Skilled in analyzing claims data trends to develop strategies that improve operational efficiency and claims performance.
Demonstrated leadership in supervising, mentoring, and developing claims management teams.
Effective communication and collaboration skills to build relationships with internal and external stakeholders.
Minimum Qualifications:
Bachelor's degree and 2 years' experience in insurance claims or relevant area OR 4 years' experience in insurance claims or related area
