Medical Claims Manager

Overview

Amwins Self-Funded is seeking a Medical Claims Manager to lead its claims team, enhance daily operations, and provide outstanding client and partner support. This primarily on-site role offers hybrid flexibility with the option to work from home up to two days a week after training completion.

Why Work with Amwins?

• Flexible work arrangements combining office presence with scheduling options promoting work-life balance.
• Robust benefits including competitive packages, generous paid time off, and paid holidays.
• An environment fostering continuous learning, professional development, and career advancement.
• Leadership opportunities involving team coaching, process optimization, and enriching client interactions.
• A performance-driven annual bonus program acknowledging achievements and shared success.

Key Responsibilities

• Oversee daily operations and support of the Claims team, including staffing decisions, promotions, performance reviews, and disciplinary processes.
• Facilitate ongoing performance management through feedback, accountability discussions, training, and technical coaching.
• Collaborate with the Claims Quality team to utilize audit data for team development and operational oversight, monitoring quality trends and supporting members needing extra assistance.
• Maintain and manage the master list tracking claims service parameters for groups and cases.
• Allocate client account tasks based on team and individual workloads where applicable.
• Supervise filing processes related to Stop Loss Claims within the department.
• Act as a subject matter expert for complex claims, offering guidance and oversight to ensure accuracy and compliance.
• Conduct claim reviews, process reimbursement filings, and manage reporting to Stop Loss carriers as needed.
• Generate monthly claims reports and notifications for Stop Loss carriers when required.
• Participate in developing and implementing policies, procedures, and improvements to strengthen claims operations.
• Collaborate with leadership to ensure consistent, high-quality service delivery to clients.
• Cultivate positive working relationships internally across departments and externally with carriers, brokers, consultants, and administrators to facilitate excellent client service.
• Partner with trainers to address skill gaps and coordinate training initiatives for team development.
• Perform additional duties and special projects as assigned.

Required Qualifications and Skills

• Minimum of 2 years in management roles, demonstrating passion for coaching and developing people.
• Bachelor's degree preferred or alternatively 3 to 5+ years of experience within Group Benefits.
• Preferred background includes 3 to 5 years in claims or similar production environments.
• Proficiency with Microsoft Office suite: Excel, Outlook, SharePoint, and Teams.
• Excellent time management with the ability to prioritize tasks and meet deadlines effectively.
• Strong collaboration skills, able to work respectfully and cooperatively with teams and business partners.
• High levels of organization and capability to manage multiple tasks simultaneously.
• Clear, professional communication skills both internally and externally.
• Exceptional attention to detail, reliable follow-through, and proactive urgency.
• A leadership approach focused on support, problem-solving, and commitment to team and organizational success.

Additional Information

The role aims to foster a supportive and empowering workplace where team members can excel. Reasonable accommodations will be provided to qualified individuals with disabilities to fulfill primary job responsibilities.