Senior Claims Manager
2 weeks ago
Who we are:
ManhattanLife Insurance and Annuity Company was founded in 1850, the Company’s longevity makes it one of the oldest and most reliable health and life insurance companies in the country. Operating successfully for 174 years is a testimony to ManhattanLife’s enduring history, and an indicator of the reliability of our future. ManhattanLife’s headquarters are in Houston, TX and the company is continually growing with multiple office locations nation-wide. ManhattanLife offers attractive employee benefits starting day one, including immediate coverage under our health, dental and vision plans. We offer flexible schedules, including shortened hours on Fridays, free parking, company-wide events, professional development (LOMA testing) and a company-wide wellness program.
Scope and Purpose:
We are seeking a Senior Claims Manager for our Plano, TX office. In the role of Senior Claims Manager, you will lead and oversee the claims department, ensuring efficient and accurate processing of insurance claims for our clients. You will be responsible for managing a team of claims professionals, implementing best practices, and maintaining compliance with industry regulations. Your role is critical in driving operational excellence, enhancing client satisfaction, and achieving organizational objectives.
Duties and Responsibilities:
- Oversee the end-to-end claims process, including claim intake, investigation, evaluation, adjudication, and settlement, ensuring timely and accurate processing while adhering to company policies and regulatory requirements.
- Provide leadership, guidance, and mentorship to a team of claim examiners, and support staff, providing guidance, performance feedback, and training to foster a culture of excellence, accountability, and continuous improvement.
- Serve as the primary point of contact for key clients, building and maintaining strong relationships, addressing client inquiries and concerns, and proactively identifying opportunities to enhance service delivery.
- Develop and implement quality assurance procedures to maintain accuracy, consistency, and timeliness of claims processing, conducting regular audits and providing feedback for improvement as necessary.
- Collaborate with external vendors, including legal counsel, medical providers, and investigative agencies, to support claim investigations, manage litigation, and optimize claim outcomes.
- Analyze claims data and performance metrics to identify trends, patterns, and opportunities for process optimization, cost containment, and risk mitigation.
- Ensure compliance with state and federal regulations governing claims processing, including HIPAA, ADA, FMLA, and other relevant laws and guidelines.
- Develop, review, and update claims handling procedures, guidelines, and policies in alignment with industry best practices and regulatory requirements.
- Prepare and present regular reports on claims activity, performance metrics, and key performance indicators to senior management and clients, highlighting areas of success and opportunities for improvement.
Minimum Qualifications:
High School Graduate or equivalent (GED).
Knowledge, Skills and Abilities:
- At least 5-7 years of progressive experience in claims management within the insurance industry, with at least 3 years in a supervisory or managerial capacity. Experience in a TPA environment is highly desirable.
- Thorough understanding of insurance principles, coverage types, and claims handling practices.
- Strong leadership qualities, including the ability to inspire and motivate team members and foster a collaborative work environment.
- Excellent communication skills, with the ability to effectively communicate with Executive leadership, external clients, and third-party vendors.
- Proven problem-solving skills with the ability to identify issues, develop practical solutions, and implement corrective actions in a dynamic and fast-paced environment.
- Familiarity with claims management software systems and proficiency in Microsoft Office Suite.
- Commitment to upholding ethical standards, integrity, and confidentiality in all aspects of claims management.
Travel Requirements:
This position may require light travel as needed.
Professional Development:- Establish annual objectives for professional growth.
- Keep pace with developments in the discipline.
- Learn and apply technologies that support professional and personal growth.
- Participate in the evaluation process.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is regularly required to stand; walk; use hands to finger, handle or feel objects, type, and use mouse; reach with hands and arms and talk and/or hear. The employee is required to sit for extended periods of time. The position may require lifting, pulling or moving items weighing upwards of 10 pounds as it relates to office or desk supplies.
Work Environment:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee regularly works in an office environment. This role routinely uses standard office equipment such as computers, phones via WebEx, physical phone while in office, and photocopiers when necessary.
Other Duties:Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to the job at any time without notice.
AAP/EEO Statement:ManhattanLife prohibits discrimination based on race, religion, gender, national origin, age, disability, veteran status, marital status, pregnancy, gender expression or identity, sexual orientation, or any other legally protected status. EOE Employer/Vet/Disabled. ManhattanLife values differences. We are committed to fostering an environment that attracts and retains a diverse workforce. With individuals from a variety of backgrounds, ManhattanLife will be better equipped to service our customers, increase innovation, and reduce risks. We encourage the unique perspectives of individuals and are dedicated to creating a respectful and inclusive work environment.
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