Claims Services Manager

Claims Services Manager

Join UHA as a Claims Services Manager and lead the daily operations of our Claim Services and Claim Services Adjustments teams. This leadership role is responsible for ensuring operational excellence in claims processing, maintaining quality and turnaround standards, supporting team development, and driving continuous process improvement across the department.

The ideal candidate is a strong people leader with health insurance claims expertise, excellent analytical skills, and a commitment to operational excellence.

Essential Responsibilities

• Manage the daily operations of the Claim Services and Claim Services Adjustments departments
• Directly supervise Claim Services Supervisors and Claim Services Adjustments Representatives
• Monitor claims inventory, productivity, quality, and turnaround metrics to ensure department standards are met
• Establish and maintain departmental policies, procedures, and performance benchmarks
• Ensure claims processing accuracy, payment accuracy, and compliance with regulatory and internal standards
• Oversee complex claims, including special handling, out-of-state network claims, high-cost inpatient claims, and reinsurance claims filing
• Identify opportunities to improve workflow efficiency, automation, and administrative processes
• Partner with internal departments, including Financial Services and Information Systems, on process and system enhancements
• Develop, coach, and evaluate staff through training, performance management, and ongoing development
• Prepare reports, presentations, and operational updates for leadership

Required Qualifications

• Bachelor's degree or equivalent combination of education and relevant work experience required
• Minimum 5 years of supervisory experience in health insurance claims or related healthcare operations
• Strong knowledge of claims processing, claims adjustments, billing, coding, and benefits administration
• Experience managing operational metrics, productivity standards, and service‑level expectations
• Strong leadership, communication, analytical, and problem‑solving skills
• Proficiency in Microsoft Office, including Excel and Word

Preferred Qualifications

• CPC (Certified Professional Coder) certification preferred
• Knowledge of healthcare insurance regulations and compliance standards
• Experience with process improvement and workflow optimization
• Strong analytical and reporting skills

This position requires residency on O?ahu, Hawai?i

Competitive compensation & excellent benefits offered