Health Insurance Claims Manager

Who we are :

ManhattanLife Insurance and Annuity Company was founded in 1850, the Company's longevity makes it one of the oldest and most reliable health and life insurance companies in the country. Operating successfully for 175 years is a testimony to ManhattanLife's enduring history, and an indicator of the reliability of our future. ManhattanLife's headquarters are in Houston, TX and the company is continually growing with multiple office locations nation-wide. ManhattanLife offers attractive employee benefits starting day one, including immediate coverage under our health, dental and vision plans. We offer flexible schedules, including shortened hours on Fridays, free parking, company-wide events, professional development (LOMA testing) and a company-wide wellness program.

Scope and Purpose :

ManhattanLife is seeking a Claims Manager for our Health Acquisitions department. As a Health Insurance Claims Manager, you will oversee the daily operations of a team that processes benefits payable under several of our indemnity insurance policies. Your objective will be to ensure this department reviews all claims accurately, promptly, and thoroughly while providing an industry leading customer experience for our claimants.

Duties and Responsibilities :

• Establish and maintain exceptional recruiting standards to acquire a high caliber of people with diverse skills and background.
• Work with leadership to establish and implement a strategic staffing strategy.
• Organize and improve the documentation and procedures provided in the onboarding process for new employees and training refreshers to tenured employees.
• Effectively apply and enforce ManhattanLife HR policies and practices, i.e., FML, Attendance, Code of Conduct, Disciplinary Guidelines.
• Conduct daily and weekly analysis of reports to identify trends, coordinate work activity, maximize productivity, and ensure the highest level of customer service is achieved.
• Ensure all claims are assigned in a timely manner to the appropriate claim examiner based on workload, claim volume, type of claim and examiner's level of experience.
• Analyze key metrics, customer communications, and direct "on the floor" observations to make informed decisions toward the improvement of all claim handling functions.
• Foster an inclusive and positive team environment within the department and demonstrate strong leadership skills.
• Utilize a reward system to recognize all factors of performance, business results, and personal effectiveness.
• Accurately determine complex claim benefits payable based on medical records, contract language and any additional information needed to reach the appropriate decision in a timely manner. This includes both payment and denial of benefits.
• Evaluate high dollar claims and present information for approval to upper management as required.
• Communicate with external and internal customers to obtain specific claim information to finalize claims and to explain claim handling.
• Review and respond to escalated claim inquiries, claim appeals, and complaints in a timely manner.
• Coach staff to address customer needs with empathy and provide effective communication verbally and in writing.
• Provide strong support and development to all staff members to achieve metrics within their role and advancement opportunities.
• Complete performance appraisals for all direct reports monthly, quarterly, and annually.

Minimum Qualifications :

Bachelor's degree or equivalent relevant work experience in the insurance or finance industries.

Knowledge, Skills and Abilities :

Travel Requirements :

This position may require light travel within a ten-mile radius from one office location to another as needed.

Professional Development :

Physical Demands :

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is regularly required to stand; walk; use hands to finger, handle or feel objects, type, and use mouse; reach with hands and arms and talk and / or hear. The employee is required to sit for extended periods of time. The position may require lifting, pulling or moving items weighing upwards of 10 pounds as it relates to office or desk supplies.

Work Environment :

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee regularly works in an office environment. This role routinely uses standard office equipment such as computers, phones via WebEx, physical phone while in office, and photocopiers when necessary.

Other Duties :

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to the job at any time without notice.

AAP / EEO Statement :

ManhattanLife prohibits discrimination based on race, religion, gender, national origin, age, disability, veteran status, marital status, pregnancy, gender expression or identity, sexual orientation, or any other legally protected status. EOE Employer / Vet / Disabled. ManhattanLife values differences. We are committed to fostering an environment that attracts and retains a diverse workforce. With individuals from a variety of backgrounds, ManhattanLife will be better equipped to service our customers, increase innovation, and reduce risks. We encourage the unique perspectives of individuals and are dedicated to creating a respectful and inclusive work environment.