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Claims Manager

United States - Remote

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.

 

The Claims Manager will lead the day-to-day operations of the claims department, ensuring high-quality service delivery, compliance with regulatory requirements, and alignment with organizational goals. This role will drive operational excellence, support staff development, and implement strategies that enhance efficiency, accuracy, and customer satisfaction across all claim functions.

Responsibilities

  • Lead and manage the claims team to achieve optimal performance aligned with company goals and best practices.

  • Oversee daily claims production, ensuring accuracy, timeliness, and compliance with internal and external standards.

  • Provide technical guidance on claim investigation, reserving, evaluation, and resolution.

  • Prepare and deliver reports and analyses in accordance with defined standards.

  • Identify strategic opportunities through financial analysis, forecasting, and cost/benefit evaluations.

  • Collaborate with internal and external stakeholders to identify gaps and implement corrective strategies.

  • Partner with Compliance and Risk teams to ensure adherence to all regulatory and internal control requirements.

  • Develop and implement performance metrics, accountability systems, and business updates to keep the team aligned with organizational objectives.

  • Foster a culture of trust, communication, and continuous improvement within the claims department.

  • Stay current on industry trends and apply insights to improve claims management strategies.

Qualifications

  • Minimum 5 years of experience in medical claims analysis and adjudication, including dental and vision.

  • At least 3 years of leadership experience in a supervisor or manager role, with demonstrated success in managing teams.

  • Strong understanding of CPT, ICD-9, and general coding terminology.

  • Proficiency in claims systems and analytical tools.

  • Excellent communication and interpersonal skills.

  • Strong organizational and time management skills; able to manage competing priorities effectively.

Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.

Pay Transparency

$70,000 - $90,000 USD

Benefits:
  • Comprehensive medical, dental, vision, and life insurance coverage
  • 401(k) retirement plan with employer match
  • Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
  • Paid time off (PTO) and disability leave
  • Employee Assistance Program (EAP)

 

Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.

 

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