Medical Claims Manager

About the Role

Amwins Self-Funded seeks a dedicated Medical Claims Manager to oversee and support a specialized claims team, enhance daily operations, and ensure outstanding client service. This position is primarily based on-site in Glendale, AZ, with the option to work remotely up to two days per week after completing initial training.

Company Values and Benefits

• Flexible work arrangements combining in-office presence with hybrid scheduling to support work-life balance.
• A competitive benefits package including generous paid time off and holidays starting from day one.
• An environment that promotes continuous learning, professional development, and career advancement.
• A leadership role that enables coaching of team members and improvement of operational processes.
• An annual bonus program rewarding individual contributions and team success.

Key Responsibilities

• Manage daily activities and provide leadership to the Claims team, including making staffing decisions, handling promotions, conducting performance reviews, and managing disciplinary actions as necessary.
• Support team member performance through ongoing feedback, accountability discussions, targeted training, and technical coaching in partnership with the Claims Lead.
• Collaborate with the Claims Quality team to utilize audit results for team development and operational oversight, reviewing quality trends and requesting escalated audit support where needed.
• Maintain the master log of groups and cases within the Claims Department, ensuring compliance with contractual claim service standards.
• Allocate client account assignments effectively according to workload demands when applicable.
• Oversee filing procedures for Stop Loss Claims within the department.
• Serve as an expert resource for complex claims and high-priority submissions, offering oversight and guidance to team members.
• Review claims and manage reimbursement filing and reporting to Stop Loss carriers as required.
• Create and distribute monthly claims reports and notifications to Stop Loss carriers when applicable.
• Drive enhancements in policies, procedures, and processes improving Claims operations.
• Work with the Director of Claims to maintain consistent high-quality client service delivery.
• Foster strong, collaborative relationships internally and externally with stakeholders such as carriers, brokers, consultants, and administrators to support effective client service.
• Partner with Claims Trainers to identify skills gaps, coordinate training initiatives, and promote team development.
• Perform other projects and duties as assigned.

Qualifications and Skills

• Minimum of two years in a management role with a focus on coaching and developing staff.
• Preferred: Bachelor's degree or 3–5+ years of experience in Group Benefits.
• Preferred industry experience includes 3–5 years in claims or a production-oriented environment.
• Proficiency in Microsoft Office Suite, particularly Excel, Outlook, SharePoint, and Teams.
• Excellent time management skills with the ability to prioritize and meet deadlines efficiently.
• Strong collaboration abilities and respectful teamwork with colleagues and business partners.
• Good organizational skills and capacity to manage multiple tasks simultaneously.
• Effective communication skills for professional interactions with internal teams and external partners.
• High attention to detail, follow-through, and a proactive sense of urgency.
• A leadership approach that is supportive, solution-focused, and driven by team and organizational success.

Additional Information

This description highlights primary responsibilities and qualifications but is not exhaustive. Reasonable accommodations can be made to support individuals with disabilities in performing essential functions.