Claims Manager
Job in
Clearwater, Pinellas County, Florida, 34623, USA
Listing for:
Premier Administrative Solutions
Full Time
position
Listed on 2025-12-27
Job specializations:
-
Management
Program / Project Manager, Risk Manager/Analyst
-
Insurance
Risk Manager/Analyst
Salary/Wage Range or Industry Benchmark: 60000 - 100000 USD Yearly
USD
60000.00
100000.00
YEAR
Job Description & How to Apply Below
Overview
Claims Manager - Health Insurance Policies or Benefits
Summary: Premier Administrative Solutions (PAS) is a Third-Party Administrator (TPA) which provides a wide range of administrative services to insurance companies, sharing organizations, insurance marketing organizations, and employers. One core service, claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost controls and ultimately adjudicated, resulting in an explanation of handling to the submitter.
This service is provided subject to service level agreements which mandate a high level of service measured by timely turnaround and a high degree of accuracy. Accuracy is measured by adherence to all written procedures and controls applicable to claims as well as the client’s stated coverage.
Join Premier Administrative Solutions as a Claims Manager and lead our Claims Department in delivering exceptional service to insurance companies, employers, and members. In this pivotal role, you’ll oversee claims adjudication, drive operational strategy, and ensure high accuracy and timely service per our service level agreements. You’ll manage relationships with vendors, spearhead quality improvements, and foster a culture of transparency and member-focused service.
With at least 5-7 years of claims operations management experience and strong leadership skills, you’ll shape department success through budgeting, staffing, and innovative automation strategies. If you’re ready to make a meaningful impact in a dynamic third-party administration environment, this is your opportunity to shine.
Responsibilities
Essential Duties and Responsibilities:
Participating actively as a key member of the PAS’ Management Team, including demonstrating leadership through strong communications skills, use of business metrics to determine strategy and resource needs, and showing a high level of focus on continual quality improvement.Coordination of all activities of the Claims Department Management Team, including Supervisors and/or Team Leaders assigned to PAS’ Customers.Responsibility for Claims Department strategy, planning, staffing projection, budgeting and quality assurance and improvement.Responsibility for final hiring decisions on employees within the Claims Department to ensure that high standards are maintained.Creating a culture within the Claims Department of exceptional service to members and their providers, as well as transparency in reporting results, trends and issues to Senior Management and clients.Management of relationships with Preferred Provider Organizations and Reference-Based Pricing vendors essential to managing the cost of claims for clients.Management of relationships with essential vendors involved with the Claims Adjudication process.Identification and management of Subject Matter Experts (SMEs) with back-ups in various aspects of Claims.Oversight of Claims Training programs, including training for new employees and ongoing reinforcement training.Oversight of Claims documentation, including Policies and Procedures and reference materials.Participates in RFP/Proposal processes, including participation in prospective client presentations.Essential Duties Specific to Claims Department:
Participation in product development, including the technical review of new products and prospective new clients.Ensuring that daily reporting provides an accurate portrayal of claims on hand.Developing and implementing strategies for greater automation in the claims process.Establishing production requirements for Examiners and monitoring performance against the requirements.Establishing and monitoring strong operational controls relating to claims cost control.Monitoring and continually developing Policies and Procedures intended to enforce consistency in process and improve quality.Working with the Manager of Quality to implement appropriate standards for accuracy and audit procedures.Using audit results to develop ongoing training programs and new procedures.Coordinating escalations from other Departments with the Claims Supervisor.Reviewing and…
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