Senior Claims Manager
Listed on 2026-01-27
-
Management
Program / Project Manager, Risk Manager/Analyst, Healthcare Management, Operations Manager
Overview
Industry: Health Insurance Policies & Benefits
Location: Clearwater, FL (In-Office)
Salary: $120,000–$130,000, based on experience
Schedule: Full-Time, Monday–Friday, 8:00 AM–5:00 PM
About the Role
Are you a high-performing claims leader ready to take your career to the next level? A leading Third-Party Administrator (TPA) is seeking a Senior Claims Manager to provide strategic leadership and operational oversight for a fast-paced, high-volume Claims Department.
In this role, you’ll drive operational excellence, compliance, and quality
, ensuring every claim is processed accurately, efficiently, and in alignment with health plan requirements. You’ll lead a talented team, optimize workflows, manage vendor relationships, and deliver exceptional service to insurance companies, employers, and members.
This is a hands-on leadership role for a solutions-driven, results-oriented professional with deep TPA experience
. If you’re ready to lead, innovate, and make a real impact, this role is for you.
Leadership & Strategic Oversight
- Serve as a senior member of the management team, influencing departmental strategy and operational performance.
- Lead and mentor Claims Managers, Supervisors, and senior staff to align with organizational goals.
- Develop strategies for performance improvement, staffing, budgeting, and workflow efficiency.
- Foster a culture of accountability, transparency, and service excellence.
- Lead hiring decisions, succession planning, and professional development initiatives.
- Oversee relationships with PPO networks, reference-based pricing partners, clearinghouses, cost-containment vendors, and claims fulfillment partners.
- Manage escalated client issues and maintain strong working relationships with key accounts.
- Support RFP responses, proposals, client presentations, and process/product improvement initiatives.
Claims Operations & Compliance
- Oversee end-to-end claims operations including receipt, re-pricing, adjudication, auditing, approvals, and payments.
- Lead automation initiatives, including electronic claims receipt, auto-adjudication, and workflow optimization.
- Ensure compliance with medical necessity reviews, pre-existing condition policies, reasonable charge determinations, and third-party liability protocols.
- Maintain up-to-date documentation, SOPs, and training programs.
- Collaborate with Quality Management to set accuracy benchmarks, audit practices, and authority levels.
- Analyze audit results, KPIs, and operational data to drive continuous improvement.
- Review high-dollar or complex claims prior to payment.
- Monitor department performance metrics including SLAs, cost per claim, client satisfaction, and audit results.
Required:
- 5–7+ years in a management role for claims operations, servicing health insurance policies or benefits
. - Must have deep TPA experience
. - Strong organizational, interpersonal, and motivational skills.
- Proven ability to lead high-volume claims operations and cross-functional teams.
Preferred:
- Bachelor’s degree in Business, Health Administration, or related field.
- Experience with claims automation, auto-adjudication, and vendor management.
- In-office role with extensive computer use, communication, and data entry.
- Occasional lifting up to 30 lbs; extended periods of sitting may be required.
- Medical, Dental & Vision Insurance (vision fully company-paid)
- HSA and FSA options
- Company-paid Life & Disability insurance
- Generous PTO and paid holidays
- 401(k) with company match (eligibility-based)
- Employee Assistance Program
- Frequent recognition events & appreciation programs
- Clear opportunities for advancement
- Collaborative, high-retention workplace
- Convenient Clearwater office location
This is a rockstar-level leadership opportunity for a strategic, results-driven professional with a passion for claims operations. You’ll have high visibility with senior leadership
, the chance to shape processes, lead a dynamic team, and make a meaningful impact on members and providers.
If you are a Senior Claims Manager with TPA experience looking to lead a high-performing, innovative team
, this is your chance to shine.
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