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Claims Team Manager
<p>A top-rated Health Administration Company with over 50 years of industry leadership is seeking an experienced <strong>Claims Manager</strong> to join our growing team. Located in <strong>Katy, TX</strong>, just off <strong>Highway 99 and Westpark Tollway</strong>, we’ve been serving our clients since <strong>1970</strong> and remain at the forefront of our industry.</p><p>This is an excellent opportunity for a hands-on leader who thrives in a fast-paced environment and is passionate about operational excellence, team development, and process improvement.</p><p><strong>Position Overview</strong></p><p>The Claims Manager is responsible for the overall direction, coordination, and performance of the Claims Department. This role works closely with cross-functional teams including IT, Account Management, Stop Loss, Customer Service, Medical Help Line, and Sales to ensure accurate, timely claims processing and exceptional client service.</p><p><strong>Key Responsibilities</strong></p><ul><li>Lead, coach, and manage the Claims team with a strong presence</li><li>Oversee claims operations including High Dollar Claims, Plan Build, ID Cards, Provider setup, and VBA testing</li><li>Develop and implement strategies to increase auto-adjudicated claims to 50%</li><li>Monitor productivity, quality, and turnaround metrics (30 days for 100% of claims; 14 days for 90%)</li><li>Identify performance trends and implement corrective or improvement initiatives</li><li>Manage claims inventories, work queues, and exception handling</li><li>Resolve complex or escalated claims issues and prevent recurring problems</li><li>Ensure compliance with company policies, contractual standards, and audit requirements</li><li>Recommend and implement workflow, policy, and procedural improvements</li><li>Lead training, cross-training, and onboarding in partnership with HR</li><li>Prepare and present management reports highlighting trends, risks, and recommendations</li><li>Partner with Sales and Account Management to support new client implementations and renewals</li></ul><p><strong>Qualifications</strong></p><ul><li>5+ years of supervisory experience and 3+ years of management experience in group health claims</li><li>Strong knowledge of commercial health insurance products (HMO, PPO, EPO, HDHP, HRA/HSA)</li><li>Expertise in claims adjudication, eligibility, and benefit determination</li><li>Experience working with stop loss carriers and direct provider agreements</li><li>Knowledge of CPT and ICD-10 coding</li><li>Strong leadership, communication, and team-building skills</li><li>Ability to thrive in a high-volume, fast-paced environment</li><li>Advanced organizational and workflow design skills</li><li>Proficiency in MS Office; VBA experience a plus</li></ul><p>✨ <strong>Why Join Us?</strong></p><ul><li>Stable, established company with a strong reputation</li><li>Collaborative culture and cross-functional leadership exposure</li><li>Opportunity to make a measurable impact on operations and growth</li></ul>
