Medical Claims Manager

About the Role

Amwins Self-Funded is seeking a Medical Claims Manager to lead and support a dedicated claims team, optimize daily operations, and ensure outstanding service delivery to clients and partners. This primarily in-office position allows up to two days per week of remote work after training completion.

Why Work at Amwins?

• Flexible hybrid work schedule balancing in-office presence with remote opportunities.
• Comprehensive benefits including competitive health packages, generous paid time off, and paid holidays.
• Opportunities for continuous learning, professional development, and career advancement.
• Leadership role with coaching responsibilities aimed at process improvements and fostering a positive client experience.
• Annual performance-based bonuses recognizing contributions and shared success.

Key Responsibilities

• Lead daily operations and support the success of the Claims team including staffing decisions, promotions, evaluations, and disciplinary measures.
• Manage team performance through feedback, accountability discussions, training, and coaching in partnership with the Claims Lead.
• Collaborate with the Claims Quality team to analyze audit findings, monitor quality trends, and escalate support as needed.
• Maintain the master list of groups and cases including contractual claims service agreements.
• Allocate client accounts to team members based on workload demands.
• Oversee filing processes specifically for Stop Loss Claims within the department.
• Serve as a subject matter expert on complex claim submissions, providing oversight and guidance on claims and correspondence.
• Review claims, oversee reimbursement filing, and manage reporting to Stop Loss carriers as necessary.
• Produce monthly claims reports and notifications to carriers when applicable.
• Drive process enhancements by contributing to policy and procedure development improving claims operations.
• Work with the Director of Claims to maintain high-quality and consistent service delivery to clients.
• Foster collaborative relationships internally among departments and externally with carriers, brokers, and administrators to enhance client service.
• Partner with Claims Trainers to identify skill gaps and coordinate training programs supporting team growth.
• Perform additional duties and special projects as assigned.

Candidate Qualifications

• Minimum of 2 years management experience with a dedication to coaching and staff development.
• Preferred Bachelor's degree or 3–5+ years of experience in Group Benefits.
• Experience of 3–5 years in claims processing or production-driven environments is preferred.
• Proficiency with Microsoft Office suite including Excel, Outlook, SharePoint, and Teams.
• Strong time management skills to prioritize workload and meet deadlines efficiently.
• Excellent teamwork abilities with cooperative and respectful interpersonal skills.
• Highly organized with strong multitasking capability.
• Effective and professional communication skills for interaction with internal teams and external partners.
• Meticulous attention to detail along with a strong sense of urgency and completion follow-through.
• A leadership approach emphasizing supportiveness, solutions orientation, and commitment to team and business success.

Additional Information

This description outlines the primary duties and qualifications for the role but is not exhaustive. Reasonable accommodations are available for individuals with disabilities to perform essential job functions.