Sr Manager, Claims Operations

Job Description

Job Description

Position Summary

The Senior Manager of Claims Operations is responsible for overseeing the intake, adjudication, and processing of medical claims in compliance with ERISA, CMS, and health plan guidelines. This leadership role ensures strategic operational excellence, fosters vendor and partner collaboration, and drives continuous process improvements. The Senior Manager will provide mentorship to a growing team of claims and appraisal staff, develop and implement policies, and ensure high levels of service delivery for stakeholders.

Key Responsibilities

Department Leadership & Oversight

• Manage day-to-day operations of the claims department, ensuring claims are processed accurately, timely, and in compliance with regulatory requirements.
• Supervise and develop appraisal and examination staff while providing technical guidance to claims teams, producers, and account managers.
• Handle escalated, complex, or high-value claims with deep subject matter expertise, particularly in Workers’ Compensation statutes and best practices.

Strategic Operations & Compliance

Vendor & Partner Management

Mentorship & Staff Development

Customer & Stakeholder Service

Data Analysis & Process Improvement

Qualifications

Demonstrated ability to lead and develop high-performing teams.

AMM BENEFITS

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