Medical Claims Manager

About the Role

Amwins Self-Funded seeks a dedicated Medical Claims Manager to lead a claims team, enhance daily operations, and ensure outstanding client service. This primarily on-site position offers the flexibility to work remotely up to two days a week after the initial training period.

Why Join Amwins?

• Enjoy a primarily in-office role with options for hybrid work and flexible scheduling to maintain work-life balance.
• Benefit from a comprehensive package including competitive benefits, generous Paid Time Off, and paid holidays starting day one.
• Advance your career in a collaborative environment that values continuous learning, growth, and professional development.
• Lead a team with purpose by coaching, refining processes, and contributing to positive experiences for clients and partners.
• Participate in an annual performance-based bonus program recognizing your achievements and contributions.

Key Responsibilities

• Lead daily activities of the Claims team, overseeing staffing, promotions, evaluations, and disciplinary measures as needed.
• Support team performance through consistent feedback, training, coaching, and accountability in partnership with Claims Lead.
• Collaborate with Claims Quality to analyze audit findings for team growth and operational management; review QA reports regularly and escalate audit needs where necessary.
• Manage the master list of groups/cases within Claims, ensuring adherence to contractual service requirements.
• Allocate client accounts to team members based on workload dynamics.
• Oversee filing processes for Stop Loss Claims within the department.
• Act as a subject matter expert on complex claims and high-priority submissions, offering guidance to the team.
• Execute claim reviews, reimbursement filings, and reporting to Stop Loss carriers as required.
• Generate and distribute monthly claims reports and communications to Stop Loss carriers when applicable.
• Contribute to the enhancement of Claims policies, procedures, and workflows.
• Cooperate closely with the Director of Claims to ensure consistent and high-quality client service delivery.
• Foster constructive relationships with internal departments and external partners such as carriers, brokers, and administrators to enhance client service.
• Work alongside Claims Trainer(s) to identify skill gaps and organize development programs.
• Perform additional duties and projects as assigned.

Qualifications and Skills

• Minimum 2 years of management experience with a strong passion for leading and developing others.
• Preferred: Bachelor's degree or 3–5+ years experience in Group Benefits.
• Desired: 3–5 years’ experience in claims management or production environment.
• Highly proficient with Microsoft Office applications including Excel, Outlook, SharePoint, and Teams.
• Demonstrated effective time management, ability to prioritize, and meet deadlines.
• Strong collaboration abilities, working respectfully and cooperatively with colleagues and business partners.
• Excellent organizational and multitasking capabilities.
• Clear, professional, and thoughtful communication skills with internal and external stakeholders.
• High attention to detail, strong follow-through, and a keen sense of urgency.
• Leadership approach grounded in supportiveness, solution orientation, and commitment to team and business success.

Additional Information

This description highlights the primary functions of the job but does not cover all potential responsibilities or qualifications. Reasonable accommodations are available to individuals with disabilities to perform essential duties.