Senior Manager, Stop Loss & Health Claims
Core
Lead complex claims operations, including evaluation, investigation, negotiation, and settlement of medical stop-loss and health insurance claims.
Role type
Senior Manager, Claims Operations
Builds
Efficient claims processing workflows and optimal policyholder outcomes
Domain
Health Insurance / Stop-Loss
Required skills
Medical stop-loss insurance expertise, Health insurance claims management, Team leadership, Process optimization, Stakeholder management, Regulatory compliance knowledge, Data analysis, Negotiation, Claims management systems proficiency
Responsibilities
Direct evaluation, investigation, negotiation, and settlement of complex claims; Supervise, mentor, and manage a high-performing claims team; Monitor workflow and implement operational efficiencies; Collaborate with third-party administrators, brokers, agents, and legal counsel.
Seniority
Senior, hands-on IC with management responsibilities