CrawlJobs Logo

System Manager Claims

United States, Rancho Cordova Employment contract 43.10 - 64.11 USD / Hour · Job Posted May 04, 2026
Apply Position
Job Link Share

Job Description

As our System Manager, Claims, you will be responsible for the investigation, evaluation, and disposition of healthcare-related property and/or liability claims and lawsuits that are of a significant and complex nature. You will direct facility professionals on claim investigations that produce accurate facts and lead to timely as well as objective analysis of all assignments.Every day, under limited direction, this position will have high levels of authority to negotiate on behalf of the organization with opposing litigants and attorneys to resolve disputes and lawsuits. You will assist in the coaching, training, and mentoring of other team members and serve as a subject matter expert on specialty claims or risks.To be successful in your role, you will strategically manage complex healthcare claims and litigation, ensuring thorough investigation, objective analysis, and effective resolution. You will demonstrate exceptional expertise in negotiation, risk mitigation, and providing specialized guidance, acting as a pivotal resource for both internal teams and external parties to protect the organization's interests and uphold its reputation.

Job Responsibility

  • Investigation, evaluation, and disposition of healthcare-related property and/or liability claims and lawsuits that are of a significant and complex nature
  • Direct facility professionals on claim investigations that produce accurate facts and lead to timely as well as objective analysis of all assignments
  • Under limited direction, this position will have high levels of authority to negotiate on behalf of the organization with opposing litigants and attorneys to resolve disputes and lawsuits
  • Assist in the coaching, training, and mentoring of other team members and serve as a subject matter expert on specialty claims or risks
  • Strategically manage complex healthcare claims and litigation, ensuring thorough investigation, objective analysis, and effective resolution
  • Demonstrate exceptional expertise in negotiation, risk mitigation, and providing specialized guidance, acting as a pivotal resource for both internal teams and external parties to protect the organization's interests and uphold its reputation
  • Settlement authority up to $500,000
  • Utilizes best practice claim management techniques and provides high levels of customer service: investigates, evaluates and resolves complex claims and litigation in accordance with CommonSpirit Health Core Values and ERMG policies and procedures
  • Conducts full investigations and evaluations on reported claims or suits
  • Directs MBO professionals and retained legal counsel to develop and implement a focused strategy for timely and cost-effective resolution of complex claims and suits
  • Hires, directs, evaluates, and terminates (when appropriate) outside defense counsel
  • Hiring responsibilities include establishing hourly rates, acceptable use of associates and paralegals, and overall minimum service requirements
  • Through claim analysis, assesses economic and non-economic risk to CommonSpirit Health and establishes appropriate financial reserves for budgeting, financial and underwriting reporting
  • Coordinates and directs litigation with assigned defense counsel through proper selection, implementing specific action plans to complete case analysis and claim disposition plans

Requirements

  • Ten (10) years of high exposure medical malpractice and general liability claim management experience
  • Ten (10) years of insurance, legal, health care operations, and medical experience
  • Healthcare system claim experience

Nice to have

  • Bachelors Other Bachelor’s Degree – advanced degree
  • Insurance or claim-related professional course work

What we offer

  • Medical, prescription drug, dental, vision plans
  • Life insurance
  • Paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually)
  • Tuition reimbursement
  • Retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings

Looking for more opportunities?

Search for other job offers that match your skills and interests.

Similar Jobs for

System Manager Claims

8 matching positions

Claims Manager - International Financial Lines

An independent claims handler who will manage and oversee the end-to-end claims ...
Location
Location
United Kingdom , London
Salary
Salary:
Not provided
socialvalueportal.com Logo
Social Value Portal Ltd
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • University degree
  • Three of more years' experience handling commercial liability insurance claims, preferably under management liability and financial institution policies
  • Adjuster license(s) may be required as part of your job responsibilities. If required, those licenses must be obtained within the first 90 days of your employment and in accordance with an individual licensing plan established by Beazley Compliance and your Manager
  • Legal training or claims experience, including assessing liability and negotiating settlements
  • Functional expertise includes: claims management procedures, knowledge of both US and international insurance markets (general and specialised areas), familiarity with US and global legal and regulatory frameworks, as well as alternative dispute resolution methods
  • Analytical skills: Problem solving (broad-based, analytical, conceptual, creativity), analysis of financial statements, financial assessments of claims, data analysis and decision-making
  • Work management skills: Time and workload management, self-starter, planning, achievement orientation, productivity focused
  • Interpersonal skills: Ability to influence others, client and broker management skills, purposeful communication, flexibility, active listening
Job Responsibility
Job Responsibility
  • Proactively manage a diverse portfolio of management liability, employment practice, professional indemnity and crime claims
  • Handle claims from first notice of loss through resolution, assessing severity, complexity, and direct financial loss to determine the appropriate level of involvement based on claim type, maturity, and quantum, while working closely with brokers, insureds, and underwriting partners
  • Evaluate policy coverage in line with underwriting intent, draft clear and well-reasoned coverage position letters, and effectively communicate coverage determinations to brokers, insureds and other relevant stakeholders in accordance with Beazley’s Claims Service Standards
  • Manage portfolio of medium to high severity claims, including Category 2 and some Category 1 claims (i.e., claims with an expected or actual value in excess of $500,000 or having material coverage issues) including (depending on training and agreement of the Head of) Coverage Litigation but without allegations of bad faith
  • Review of individual claims within the portfolio on a regular basis ensuring claims records are maintained in a timely manner as required by Beazley’s claims controls and standards as well as regulatory minimums
  • Establish appropriate and timely case reserves adhering at all times to Beazley’s authority protocols and Beazley’s Claims Reserving Philosophy and Standards while using all tools available to demonstrate potential loss exposure
  • Develop, iterate, document, and execute claims strategies taking into account uncertainties, key decisions, potential outcomes, and estimated associated costs
  • Ensure the management of claims conforms to the agreed standardized processes, maintain accurate and updated claims files including proper documentation and data
  • Communicate any material claims to Reinsurance and Finance as set out by the applicable claims authority, claims controls/protocols, and procedures
  • Working with Reinsurance to effect claims recoveries
  • Fulltime
Read More
Arrow Right

Claims Manager

You'll be working at the heart of the business, with technical and marketing tea...
Location
Location
United Kingdom , Nottingham
Salary
Salary:
Not provided
boots.com Logo
Boots
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's degree in a life science discipline (e.g., Biology, Cosmetic Science, Pharmacology, Dermatology) and/or substantial experience
  • At least 5 years' experience working in a regulatory or claims environment
  • Summarise and articulate technical information to diverse audiences both verbally and in writing
  • Determine and develop approaches to solutions with technical guidance on a variety of problems of moderate scope and complexity
  • Analyse data and detect trends
Job Responsibility
Job Responsibility
  • Lead claims into Research, New Product Development, and communication plans, including understanding of Legal and Regulatory colleagues
  • Provide claims expertise during innovation stages and in product development, defining claims evidence/support strategies that aligns with regulatory assessments, underpinning science and competitor analysis
  • Work with Science and Claims teams to ensure optimised testing to target claims, building scientific expertise in claims and methodologies to improve
  • Author and reviews claims documentation/ narrative for proactive claims approval to improve value, or reactive claims challenges
  • Provide creative input into claims brainstorming, using understanding of the science, test methods, formulation efficacy and regulatory guardrails
  • Ensure GAT and BCD handover, then reviews marketing material and other assets for compliance to approved claims
  • Keep up to date with the claims landscape in key markets using claims authority requirements and adjudications, regulatory knowledge, legal activity, competitor activity and any other intel
  • Provide a risk-based expert recommendations, escalating on time any issues that could be a threat/opportunity for the business
  • Develop guidance notes for claims use and required supporting evidence
  • Lead in the strategic prioritisation, authoring & training of new standards and updates (and guidance notes) for activation in the business and submission to quality management system submission
What we offer
What we offer
  • Boots Retirement Savings Plan
  • Discretionary annual bonus
  • Generous employee discounts
  • Enhanced maternity/paternity/adoption leave pay and gift card for anyone expecting or adopting a child
  • Flexible benefits scheme including option to buy additional holiday, discounted gym membership, life assurance, activity passes and much more.
  • Access to free, 24/7 counselling and support through TELUS Health, our Employee Assistance Programme.
  • Fulltime
Read More
Arrow Right

Agency Insurance Claims Manager

Capstone, an Alera Group Company, is looking for an Agency Claims Manager. We ar...
Location
Location
United States , Manasquan, New Jersey
Salary
Salary:
50000.00 - 85000.00 USD / Year
aleragroup.com Logo
Alera Group
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Multi-line claims experience is ideal
  • Experience working in an agency or brokerage environment is a plus
  • Ability to effectively communicate both verbally and in writing
  • Computer proficiency with agency management systems, web-based tools, and Microsoft (Outlook, Excel and Word)
  • Ability to establish priorities in a fast-paced work environment and to organize time efficiently to meet or exceed deadlines
  • Ability to build trust in the team that you will be able to execute on deliverables that were committed to without constant follow-up from other team members
  • Ability to remain calm under pressure and in difficult situations, all while delivering excellent customer service
Job Responsibility
Job Responsibility
  • Be a claims advocate for clients
  • take claim calls, assist clients with claims submission to carriers, aid with claims service issues and obtain / provide claim status updates
  • Form relationships with carriers and TPAs, working closely with adjusters and other claims personnel on claims handling, ensuring proper and efficient claims resolution
  • Analyze and interpret claims information from loss runs and other sources, drawing accurate conclusions
  • Prepare status and analytic reports for Capstone Management and customers as required
  • See claims issues through to resolution, while effectively communicating with client and internal team members on the status of the claims
  • Establishing and building out the Capstone’s agency claims management process
  • Partner with Carriers and TPA’s to assure accuracy of reserves, claim status, etc.
What we offer
What we offer
  • medical, dental, life and disability insurance, 401k, generous paid time off
  • Fulltime
Read More
Arrow Right

Senior Product Manager Claims AI

Are you looking for a new challenge? Fancy helping us shape the future of motor ...
Location
Location
Italy , Milan
Salary
Salary:
Not provided
prima.it Logo
Prima
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Proven experience: 4+ years delivering complex tech products end to end, as a PM, Data Scientist or related roles
  • Strong analytical mindset: highly data driven, comfortable with metrics, trade-offs, and structured problem solving
  • AI-aware product leader: familiarity with LLMs, ML concepts, or AI-powered workflows is important
  • Technically confident: can engage deeply with engineers and data science teams on architecture, constraints, and feasibility
  • Excellent communicator: can clearly explain complex technical and strategic topics, fluent in Italian and English
Job Responsibility
Job Responsibility
  • Roadmap definition: define and evolve the roadmap for AI-driven and automated claims capabilities
  • Turn data into product decisions: use quantitative analysis, experiments, and insights to prioritise problems, validate solutions, and measure impact
  • Drive AI adoption at scale: lead initiatives that replace manual workflows with smart automation, combining rules, ML models, and LLM-based systems
  • Deliver with engineering and data science: collaborate daily with a cross-functional agile team to ship reliable, production-grade AI features
  • Partner with the business: work closely with Claims teams to deeply understand processes, pain points, and regulatory constraints, translating them into impactful product solutions
  • Contribute to strategy: help shape Prima’s broader Claims product strategy, identifying where emerging technologies can unlock step-change improvements
What we offer
What we offer
  • Work Your Way: full flexibility – work from home, the office or a mix of both
  • work from anywhere for up to 30 days a year
  • Grow with us: access to learning resources, mentorship and a growth plan tailored to you
  • Thrive and perform: private healthcare, gym discounts, wellbeing programs and mental health support
  • Fulltime
Read More
Arrow Right

Manager - Traffic & Claims

The Team: The Traffic and Purchasing team are responsible for coordinating the m...
Location
Location
United States , Dayton
Salary
Salary:
90094.58 - 106475.42 USD / Year
assessfirst.com Logo
Assessfirst
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 3-5 years of hands-on managerial experience supporting and enhancing operational workflows within Distribution and Service Center Operations
  • Bachelor's Degree preferred
  • Lead a team with different areas of expertise
  • Ability to collaborate, communicate, motivate, and support a team promoting mutual respect
  • Excellent communication and strong organizational skills
  • Solid understanding of budgeting with the ability to use sound judgment
  • Warehouse Management System experience
  • High attention to detail
  • Proven ability to meet both short- and long-term deadlines
  • Strong proficiency in Microsoft Office, including PowerPoint
Job Responsibility
Job Responsibility
  • Lead the coordination of domestic transportation activities, ensuring timely pickup and movement of materials to support boutique and corporate operational needs
  • Oversee communication and issue resolution with FedEx and other carriers, including reroute management, service escalations, and shipment status investigations
  • Ensure timely financial compliance by directing weekly follow-ups on outstanding or unbilled shipments and identifying gaps in billing processes
  • Maintain and manage comprehensive shipment and invoice tracking logs, ensuring full accuracy and reconciliation across all transportation activities
  • Support Traffic Director and Customer Service in filing claims for all theft/damage
  • Provide coordinated assistance to ensure claims are submitted accurately, completely, and on time
  • Maintain log of claims to ensure value of loss is tracked
  • Oversee a centralized tracking log to monitor claim status, reimbursement progress, and total loss impact
  • Assist in tracking and reporting KPI's
  • Maintain and enforce effective filing and record-management systems to ensure accuracy, compliance, and accessibility across traffic operations
What we offer
What we offer
  • Commission and bonus incentives based on sales performance
  • Medical, Dental, Vision
  • Life Insurance and Disability
  • Paid time off (annual vacation of 15 days, 11 company holidays, 3 floating holidays, 2 wellbeing days, and sick & safe time)
  • Paid Parental leave and transition time
  • 401(k) and Roth Retirement plan with company matching and profit sharing
  • Various voluntary benefits such as flexible spending accounts, fitness reimbursement, voluntary life insurance
  • Product discount and EAP resources
  • Access to Calm App, Health Advocate, Family Building Support and more
  • Fulltime
Read More
Arrow Right

Claims Case Manager

We are seeking a dedicated Claims Case Manager to provide comprehensive claim se...
Location
Location
United States , Oklahoma City
Salary
Salary:
26.00 USD / Hour
nttdata.com Logo
NTT DATA
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2 years in an analytical role reviewing medical benefits and claims
  • 2 years of claims adjudication experience, preferably in life, and supplemental products (e.g., critical illnesses such as cancer, stroke, heart attack, kidney disease)
  • 4 years of experience reviewing and assessing medical records
  • Experience articulating claim requirements clearly and concisely
  • Minimum high school diploma or GED
  • At least 1 year of experience working from home with proven productivity and quality
  • Designated quiet area for completing calls
  • Must live in the Continental United States
  • Must pass drug screen
  • Must pass a background check with education check and employment verification check
Job Responsibility
Job Responsibility
  • Gather information and initiate claims through various channels
  • Log and update pertinent information throughout the claim lifecycle
  • Communicate required medical records and claim information via email, mail, and phone
  • Follow up on pending claims and assist in gathering required medical records
  • Calculate benefit amounts and process payments through the claims system
  • Manage a caseload of active claims and perform end-to-end steps
  • Ensure accuracy and organization in logging, tracking, and reviewing claims
  • Identify and flag potential fraudulent activities
  • Work with management and team members to address service issues and concerns
  • Communicate with claimants with empathy and a willingness to help
What we offer
What we offer
  • Medical insurance
  • Dental insurance
  • Vision insurance with an employer contribution
  • Flexible spending or health savings account
  • Life and AD&D insurance
  • Short- and long-term disability coverage
  • Paid time off
  • Employee assistance
  • Participation in a 401k program with company match
  • Additional voluntary or legally required benefits
  • Fulltime
Read More
Arrow Right

Claims Case Manager

We are seeking a dedicated Claims Case Manager to provide comprehensive claim se...
Location
Location
United States , Lincoln
Salary
Salary:
26.00 USD / Hour
nttdata.com Logo
NTT DATA
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2 years in an analytical role reviewing medical benefits and claims
  • 2 years of claims adjudication experience, preferably in life, and supplemental products (e.g., critical illnesses such as cancer, stroke, heart attack, kidney disease)
  • 4 years of experience reviewing and assessing medical records
  • Experience articulating claim requirements clearly and concisely
  • Minimum high school diploma or GED
  • college degree preferred
  • At least 1 year of experience working from home with proven productivity and quality
  • Designated quiet area for completing calls
  • Must live in the Continental United States
  • Must Pass Drug screen
Job Responsibility
Job Responsibility
  • End-to-End Claim Management: Handle every aspect of the claim process, from intake to final decision
  • Status Updates: Provide frequent updates to claimants through their preferred communication channels
  • Document Review: Thoroughly review medical documents, claim forms, and policy notes
  • Communication: Interact with claimants with empathy and attention to detail
  • Team Collaboration: Work with team members to ensure high-quality service and resolution of issues
  • Record Keeping: Maintain accurate records and reports throughout the claims process
  • Data Analysis: Compile and analyze data to identify trends and perform root cause analysis
  • Claim Initiation: Gather information and initiate claims through various channels
  • Detailed Logging: Log and update pertinent information throughout the claim lifecycle
  • Omni-Channel Correspondence: Communicate required medical records and claim information via email, mail, and phone
What we offer
What we offer
  • medical insurance
  • dental insurance
  • vision insurance with an employer contribution
  • flexible spending or health savings account
  • life and AD&D insurance
  • short- and long-term disability coverage
  • paid time off
  • employee assistance
  • participation in a 401k program with company match
  • Fulltime
Read More
Arrow Right

Claims Case Manager

We are seeking a dedicated Claims Case Manager to provide comprehensive claim se...
Location
Location
United States , Lincoln
Salary
Salary:
26.00 USD / Hour
nttdata.com Logo
NTT DATA
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2 years in an analytical role reviewing medical benefits and claims
  • 2 years of claims adjudication experience, preferably in life, and supplemental products (e.g., critical illnesses such as cancer, stroke, heart attack, kidney disease)
  • 4 years of experience reviewing and assessing medical records
  • Experience articulating claim requirements clearly and concisely
  • Minimum high school diploma or GED
  • At least 1 year of experience working from home with proven productivity and quality
  • Designated quiet area for completing calls
  • Must Pass Drug screen
  • Must Pass a background check with Education check and employment verification check
Job Responsibility
Job Responsibility
  • End-to-End Claim Management: Handle every aspect of the claim process, from intake to final decision
  • Status Updates: Provide frequent updates to claimants through their preferred communication channels
  • Document Review: Thoroughly review medical documents, claim forms, and policy notes
  • Communication: Interact with claimants with empathy and attention to detail
  • Team Collaboration: Work with team members to ensure high-quality service and resolution of issues
  • Record Keeping: Maintain accurate records and reports throughout the claims process
  • Data Analysis: Compile and analyze data to identify trends and perform root cause analysis
  • Claim Initiation: Gather information and initiate claims through various channels
  • Detailed Logging: Log and update pertinent information throughout the claim lifecycle
  • Omni-Channel Correspondence: Communicate required medical records and claim information via email, mail, and phone
What we offer
What we offer
  • medical insurance with an employer contribution
  • dental insurance with an employer contribution
  • vision insurance with an employer contribution
  • flexible spending or health savings account
  • life and AD&D insurance
  • short- and long-term disability coverage
  • paid time off
  • employee assistance
  • participation in a 401k program with company match
  • additional voluntary or legally required benefits
  • Fulltime
Read More
Arrow Right