Risk and Insurance Management Recruiting
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Category Listing

Posted: Thursday, October 19, 2017

Employee Benefits Claims Manager

Bucks County, PA
Salary: $80,000 - $100,000

Employee Benefit Claims Manager - Bucks County, PA

Our client, a national, full-service benefits organization and Third Party Administrator (TPA is seeking a Claims Manager to support their growing organization in Newtown, PA.

This client provides a high degree of expertise in the design, communication and administration of employee benefits programs. They offer Limited-Medical, GAP, Major Medical, Dental and Vision coverages through our OptiMed brand of employee benefits products.

Founded in 1968 and recently acquired by a leading U.S. private equity firm, our client maintains its corporate headquarters in Boca Raton, Florida with additional locations in Newtown, Pennsylvania, Maryland and North Carolina. Over the next year, they will be adding locations and enhancing operations and technology capabilities to help grow their national presence, which in turn creates exciting career opportunities!

Role Summary:

Reporting to the VP, Operations, the Claims Manager will oversee and manage the claims processing operations. Additional responsibilities encompass meeting annual operational, quality and financial performance metrics, overall planning, staffing, budgeting, expense priorities, recommending and implementing changes to methods for the claims processing portion of operations, providing budget analysis, labor planning, problem resolution and coordination of activities. 

Job Components:

• Coach and mentor align operational claims processing staff, and provide general daily oversight related to the delivery of ongoing claims processing activities.

• Coordinate training & development plans for all operational staff, integrating with other departments as appropriate.

• Serve as ongoing client contact and escalation point for claims processing team.

• Ensure continuous and demonstrable improvement of team productivity resulting in increased cost effectiveness and value.

• Identify improvements resulting in more efficient, higher-quality processes

• Review, approve and ensure the currency of operational process flows, quality assurance control plans, administrative summaries, and standard operating procedures

• Support and foster integration with our 3rd party vendors, insuring compliance and quality standards are being adhered to.

• Evaluate compliance risk and adjust ongoing process deliverables as needed.

• Swiftly and effectively resolve client escalations.

• Attend and facilitate client and internal meetings, as necessary.

• Coordinate audit activities/responses as requested by compliance department.

Required Skills/Knowledge/Experience:

Minimum 5-7 years directly related experience in equivalent level position within the employee benefits industry required (including minimum 5 years supervisory experience).

• Strong organizational, problem-solving, analytical, technical, communications, budgetary, mathematical and statistical skills.

• Ability to manage multiple, complex priorities and workflows while meeting annual performance metrics.

• MS Office-working knowledge of Excel, Word, and PowerPoint.

• Ability to navigate and learn multiple systems including Claims Management Applications, and Member/Provider portals.


Bachelor’s degree required with preferred Certifications as a Certified Associate in Healthcare Information & Management Systems and Registered Health Information Administrator.


To discuss this position further, please call: Janet Vincent, Mid Atlantic Recruiter and Regional Manager, The Rogan Group, Inc. at (410) 292-2423 Cell or email jvincent@rogangroup.com 

The Rogan Group, Inc. - is an Executive Search firm that specializes in the Insurance Industry. With offices in Arizona, California and Maryland we are able to conduct projects on a Local, Regional & National basis.  This work covers both the P&C and L&H sides of the business. To review all of our insurance job openings, please visit our website at www.rogangroup.com

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