Job Summary: The Claims Department Manager is responsible for managing the day-to-day leadership, performance, and administration of claims department operations.  This position oversees claims supervisors, claim support functions, and operational initiatives to ensure timely, accurate and compliant processing of claims while meeting client, regulatory, financial, and customer service expectations.  The Claims Department Manager partners closely with the Director of Claims and other organizational leaders to identify and communicate business needs, implement operational improvements, support strategic initiatives, and drive process efficiencies.  This role is accountable for departmental performance, staff development, quality outcomes, inventory management, and the effective utilization of claims administration systems and supporting technologies.

Primary Responsibilities other duties may be assigned as necessary:

•  Participate in operational planning, workforce planning, and resource allocation activities to support Claims Department objectives.  
• Oversee the preparation, analysis, and distribution of operational, client, regulatory and management reports.
• Monitor claim payment accuracy, quality, productivity, inventory levels, turnaround times and service level performance; and develop and implement corrective action plans when performance standards are not met.   
• Ensure department policies, procedures, workflows, and operational controls are consistently applied, maintained, and updated in a timely manner.   
• Maintain a thorough understanding of company policies, organizational objectives, and operational processes that impact claims operations and employee performance.  
• Plan, direct, coordinate, and evaluate department workflows, operational priorities and special projects assigned by leadership.
• Train, coach, mentor, and evaluate direct reports, fostering employee development, accountability, and engagement.
• Lead and participate in user acceptance testing (UAT), implementation activities, and operational readiness reviews for claims-related projects, system enhancements, and process changes as needed.  
• Partner with the Director of Claims and Human Resources on hiring, employee development, performance management, disciplinary actions, promotions, and succession planning.
• Support strategic initiatives including system implementations, client conversions, operational improvements, regulatory requirements and client driven projects.
• Oversee departmental initiatives and ensure timely execution of assigned goals, projects, and deliverables.
• Maintain a strong working knowledge of our claims administrative system, workflows, interfaces, system integrations, and operational dependencies affecting claims processing. 
• Collaborate with internal business partners, vendors, clients, and technology teams to identify, define, validate, and implement business and operational requirements.
• Build and maintain effective working relationships with other department managers, supervisors, team leads, claim support staff and other employees across the organization.

Primary Skills & Requirements:  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.

• Bachelor’s Degree in Healthcare Administration, Business Administration, Insurance, or a related field preferred; equivalent education and relevant experience may be considered.
• Minimum five (5) years of proven experience in the health insurance industry with progressive responsibility  in  health claims operations.
• Demonstrated leadership experience managing supervisors and multiple operational teams.
• Familiarity with medical terminology, procedure codes, diagnosis codes, and healthcare claims processing practices preferred.
• Proficiency with Microsoft Office applications, including Word and Excel.
• Experience with claims administration systems, workflow management tools, and related operational technologies preferred.
• Demonstrated ability to interpret policy provisions, benefits, eligibility requirements, and claims payment methodologies.   
• Strong analytical, problem-solving, and decision-making skills. 
• Excellent verbal, written, and interpersonal communication skills.
• Ability to manage competing priorities and meet deadlines in a fast-paced environment.
• Ability to maintain a dependable work schedule and meet attendance expectations. 
• Ability to exercise sound judgment while maintaining confidentiality and professionalism.
• Occasional travel may be required for training, meetings, or business-related activities.
• Ability to perform work in a standard office or remote work environment, as applicable.

About Integrity

Integrity is one of the nation’s leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead.

Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge. Why? Because we put our people first! At Integrity, you can start a new career path at company you’ll love, and we’ll love you back. We’re proud of the work we do and the culture we’ve built, where we celebrate your hard work and support you daily. Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind. 

Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are — in person, over the phone or online. Integrity’s employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit Integrity.com.

Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.