Medical Claims Manager

About the Role and Company

Amwins Self-Funded is seeking a Medical Claims Manager who will lead a committed claims team, enhance daily operations, and ensure outstanding service delivery to clients and partners. This primarily on-site role offers the flexibility to work from home up to two days per week following completion of training. Joining Amwins means becoming part of a supportive and growth-oriented workplace that values collaboration, empowerment, and making meaningful contributions.

Key Responsibilities

• Lead daily activities and provide support to the assigned Claims team, including staffing advice, promotions, performance reviews, and disciplinary measures.
• Facilitate team member performance through ongoing feedback, accountability discussions, technical coaching, and training; collaborate with Claims Lead for targeted guidance.
• Work alongside the Claims Quality team to utilize audit reports for team development, performance management, and operational monitoring; review quality assurance findings regularly to track trends and request additional support as needed.
• Maintain the master list of groups and cases for the Claims Department, ensuring adherence to all contractual service parameters.
• Allocate client accounts based on team and individual workloads when relevant.
• Supervise the process of filing Stop Loss Claims within the Claims Department.
• Provide expertise and oversight on complex and high-priority claims, supporting team submissions and correspondence.
• Review claims and handle reimbursements and reporting to Stop Loss carriers as necessary.
• Generate and manage monthly claims reports and notifications for Stop Loss carriers when applicable.
• Contribute to the creation and enhancement of policies, procedures, and workflow improvements that optimize Claims operations.
• Collaborate with the Director of Claims to ensure consistent, high-quality service delivery to clients.
• Develop and maintain effective working relationships with internal departments and team members to foster strong client service experiences.
• Build and nurture positive partnerships with external stakeholders including carriers, brokers, consultants, and administrators to facilitate responsive and efficient client services.
• Coordinate with Claims Trainers to identify skill gaps, organize training initiatives, and support team member development.
• Undertake other assigned duties and projects as needed.

Qualifications

• Minimum of two years’ management experience with a strong enthusiasm for leading, coaching, and fostering team growth.
• Preferred: Bachelor’s degree or 3–5+ years experience in Group Benefits.
• Desirable: 3–5 years experience in claims handling or production environments.
• Proficient in Microsoft Office suite including Excel, Outlook, SharePoint, and Teams.
• Demonstrated ability to manage time efficiently, prioritize tasks, and meet deadlines.
• Excellent teamwork skills and capacity to collaborate respectfully with colleagues and business partners.
• Strong organizational abilities and competence multitasking across priorities.
• Exceptional clarity and professionalism in communication with internal and external stakeholders.
• Keen attention to detail with strong follow-through and a sense of urgency.
• A supportive and proactive leadership style dedicated to team and organizational success.

Additional Information

Amwins offers a workplace with flexible in-office and hybrid work options, a competitive benefits package including paid time off and holidays, ongoing professional development opportunities, and an annual performance-based bonus program. Reasonable accommodations can be provided to enable employees with disabilities to perform essential job functions.