Medical Claims Manager

Job Description

Job Description

Claims Manager — Amwins Self-Funded

Are you ready to make a meaningful impact in a collaborative, people-focused environment? Amwins Self-Funded is looking for a Claims Manager to lead and support a dedicated claims team, strengthen day-to-day operations, and help deliver exceptional service to our clients and partners. This role is primarily in-office, with the opportunity to work from home up to two days per week after completing training.

Why Choose Amwins?

At Amwins, we believe people do their best work when they feel supported, valued, and empowered to grow. We are proud to offer a workplace where team members can build strong relationships, contribute ideas, and make a meaningful impact:

• Flexibility: Enjoy a primarily in-office role with hybrid flexibility and scheduling options that support balance.
• Comprehensive Benefits: Feel supported from day one with a competitive benefits package, generous Paid Time Off (PTO), and paid holidays.
• Continual Learning and Growth: Grow your skills in a collaborative, education-focused environment that encourages learning, development, and career growth.
• Leadership Impact: Lead with purpose by coaching team members, improving processes, and helping create a positive experience for clients and partners.
• Annual Bonus Program: Be recognized for your contributions through our performance-based bonus program, designed to reward achievement and shared success.

Learn more about us at amwins.com/benefits.

What You'll Do:

• Team Leadership: Leads the day-to-day operations and supports the success of assigned Claims team members. Responsibilities may include staffing recommendations, promotions, performance evaluations, and disciplinary actions, as applicable.
• Performance Management: Supports assigned team member performance through regular feedback, accountability conversations, training, and technical coaching. Partners with the assigned Claims Lead to provide targeted coaching and process guidance.
• Quality Assurance Partnership: Partners with the Claims Quality team to use centralized audit findings in support of team development, performance management, and operational oversight. Reviews QA reports on a defined cadence to monitor team-level quality trends and requests escalated or graduated audit coverage with the QA Claims Manager for team members who may benefit from additional support.
• Document Management: Oversees the master list of groups/cases for the Claims Department, including all contractual claims service parameters.
• Workload Distribution: Manages client account assignments based on team and individual workload volume, when applicable.
• File Management: Manages and oversees the filing process for Stop Loss Claims within the Claims Department.
• Subject Matter Expertise: Serves as a trusted resource on complex claim submissions, providing oversight and support for high-priority claims. Provides guidance on team claim submissions, correspondence, and processes.
• Claim Tracking: Conducts claim reviews and processes reimbursement filing and reporting to Stop Loss carriers, when applicable or needed.
• Claim Reporting: Manages and produces monthly claims reporting and notifications to Stop Loss carriers, when applicable or needed.
• Process Improvement: Supports the development and implementation of policies, procedures, and process improvements that strengthen Claims operations.
• Service Delivery: Collaborates with the Director of Claims to support consistent, high-quality service delivery for clients.
• Relationship Building: Builds positive, collaborative relationships with internal departments and team members to support a strong client service experience.
• Carrier and Broker Relations : Builds positive, collaborative relationships with external partners, including carriers, brokers/consultants, and administrators, to support responsive and effective client service.
• Training Partnership: Partners with Claims Trainer(s) to identify department-wide or team-wide skill gaps, coordinate helpful training programs, and support team member participation and development.
• Ad Hoc: Other duties and projects as assigned.

What You'll Bring:

• Required Qualifications: 2+ years of management experience with a passion for leading, coaching, and developing others.
• Preferred Qualifications: Bachelor's degree or 3–5+ years of experience working in Group Benefits.
• Industry Experience: 3–5 years of claims or production-environment experience preferred.
• Technology Proficiency: Proficient in Microsoft Office programs, including Excel, Outlook, SharePoint, and Teams.
• Time Management: Proven ability to manage time effectively, prioritize workload, and meet deadlines.

Collaboration: Strong team skills and the ability to work cooperatively and respectfully with staff members and business partners.

• Organization: Strong organizational and multitasking skills.
• Communication: Ability to communicate clearly, professionally, and thoughtfully with internal and external partners.
• Attention to Detail: Strong attention to detail, follow-through, and a demonstrated sense of urgency.
• Leadership Style: A supportive, solutions-oriented approach with a commitment to helping the team and business succeed.

If you are a collaborative leader who enjoys developing people, improving processes, and creating a positive client experience, we would love to hear from you.

This job description is intended to summarize the primary duties and requirements of the role. It is not an exhaustive list of all responsibilities, duties, or requirements. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The Amwins Advantage: Benefits & Perks Available to Full-Time US Based Employees

• Medical, Dental, Vision available your first day of employment
• Choice of medical plans through Blue Cross Blue Shield; Kaiser available for CA employees
• Mental health support including:
• Virtual therapy
• Digital coaching
• 24/7 EAP counseling
• Company-paid Basic Life & AD&D Insurance, Short-Term Disability, and Employee Assistance Program
• Health Savings Account with company contributions 
• Health Care FSA, Dependent Care FSA, and Commuter Benefits
• Parental Leave and Adoption Assistance
• Voluntary coverage options:
• Life Insurance
• Critical Illness
• Accident
• Identity Theft Protection
• Retiree medical benefits available for Medicare-eligible retirees
• 401(k) with company match
• Generous Paid Time Off and Company Holiday Schedule
• Collaborative, continuing education focused work environment
• Career advancement opportunities