CrawlJobs Logo

System Manager Claims

americannursingcare.com Logo

American Nursing Care

Location Icon

Location:
United States , Rancho Cordova

Category Icon
Category:

Job Type Icon

Contract Type:
Employment contract

Salary Icon

Salary:

43.10 - 64.11 USD / Hour

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

Additional Information:

Job Posted:
May 04, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for System Manager Claims

Claims Manager

Are you ready to take your career to the next level? We are thrilled to announce...
Location
Location
United Kingdom , Stirling
Salary
Salary:
27000.00 - 30000.00 GBP / Year
https://www.office-angels.com Logo
Office Angels
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Previous experience as a Claims Manager or in a similar senior administrative role
  • Exceptional customer service skills with the ability to communicate effectively across various levels
  • Strong organisational skills to multitask and prioritise effectively
  • Proficiency in IT, particularly Microsoft Office and virtual filing systems
  • Familiarity with claims systems and CRMs is a plus
  • Attention to detail and accuracy in record-keeping and financial transactions
  • Excellent time management skills to meet deadlines
  • Flexibility and the ability to work independently as well as part of a team
Job Responsibility
Job Responsibility
  • Being the first point of contact, providing outstanding customer service
  • Collaborating with key stakeholders to resolve issues efficiently
  • Managing the central email inbox and responding to inquiries promptly
  • Organising and planning appointments to optimise productivity
  • Assisting directors with various administrative tasks
  • Maintaining accurate and up-to-date records
  • Producing detailed reports and managing financial transactions
  • Issuing supplier invoices while adhering to payment terms
  • Overseeing staff timesheets and annual leave requests for efficient scheduling
  • Ensuring compliance with health and safety processes in the workplace
What we offer
What we offer
  • Competitive Salary Package: Reflective of your experience and skills
  • Pension Plan: Secure your future with a comprehensive pension scheme
  • Fulltime
Read More
Arrow Right

Claims Account Manager

We’re collaborating with a respected insurance company to fill an essential role...
Location
Location
United Kingdom , Glasgow
Salary
Salary:
45000.00 - 52000.00 GBP / Year
https://www.lawesrecruitment.co.uk Logo
Lawes Consulting Group
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Support and management of important customer relationships and partners (ideally in the insurance environment.)
  • In-depth knowledge of UK Personal Lines Home & Contents and Accident & Health Travel Insurance products.
  • Management of repair and restoration within the supply chain.
  • Experience in navigating multiple reporting lines is an advantage.
  • Fluent English.
  • Good MS Outlook, MS Excel, MS PowerPoint, MS Word, MS and Data reporting suites, such as Qlik Sense or Power BI.
  • A recognised degree or equivalent academic qualification or an equivalent insurance industry certification.
Job Responsibility
Job Responsibility
  • Oversee claims activities with outsourced partners, ensuring company standards and best practices through regular reporting and meetings.
  • Develop and implement frameworks to manage the outsourced supply chain, aligning with business goals and customer outcomes.
  • Monitor the commercial performance of outsourced partners, identifying and driving improvements through data analysis and execution best practices.
  • Present performance updates internally and externally, clearly highlighting status, issues, and action plans.
  • Execute third-party administrator audits to strengthen the outsourcing control environment.
  • Ensure governance frameworks are in place, with clear policies, processes, and procedures embedded throughout operations.
  • Collaborate with the Complaints team to manage outsourced complaints activities.
  • Oversee systems supporting outsourced operations, addressing defects, identifying improvements, and supporting business testing as needed.
  • Fulltime
Read More
Arrow Right

Major Claims Manager

To process claims and to ensure that the departmental strategic initiatives, con...
Location
Location
Malaysia , Kuala Lumpur
Salary
Salary:
Not provided
https://www.allianz.com Logo
Allianz
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree in Insurance, Business, or a related field
  • At least 5 years of experience in claims assessment, preferably in the insurance industry, with a proven track record in handling Major Claims & PA claims
  • Experience in a leadership or supervisory role, particularly managing a team of junior assessors, is an advantage
  • Comprehensive understanding of the Insurance Act 1996, AMLA, Bank Negara Malaysia guidelines, and standard operating procedures
Job Responsibility
Job Responsibility
  • Assessment and approval of Major claims & PA claims within the defined approval authority limit set and committed service level
  • Review processes to propose new guidelines, rules & requirement, procedures and system enhancement for operational efficiency and effectiveness
  • Constantly monitor and review pending claims and appeal within the committed service level and make appropriate revised decision if it is within the authority limit
  • Handle enquiries and provide quality customer service to clients and agents including investigating into customer/agent’s complaints on delay in claims assessment
  • Conduct closed file and open file audit review of junior assessors
  • Liaison with Consultant Doctor and other Insurers to determine validity and liability of the Company
  • Support other section within the dept. to ensure efficiency
  • Assist Superior in the monitoring of Daily TAT, Penders’ File and work performance towards the objectives and goals of the dept
  • Assist to provide training for junior staff and contract staff
  • Clearing of Suspense Account and UMA reporting
  • Fulltime
Read More
Arrow Right

Assistant Delivery Manager – Operations (Payers Services – Claims)

We are seeking a dynamic and experienced leader to oversee our Payer Services op...
Location
Location
India , Chennai
Salary
Salary:
Not provided
accesshealthcare.com Logo
Access Healthcare LLC
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Excellent communication and people skills
  • Available to work at office in US Shift (06:00 PM to 03:00 AM IST)
  • Strong project management and client coordination skills
  • Minimum 11 years of work experience
  • Proven experience in a leadership role within Payer Services or a related field
Job Responsibility
Job Responsibility
  • Establish productivity standards for all Payer Services operations
  • Collaborate with senior leaders to develop a robust quality control system for the Accounts Receivable process
  • Propose continuous process improvements to enhance value and manage Payer Services effectively
  • Participate in the transition of new projects, engage with clients, and ensure the team meets business requirements
  • Oversee project progress and participate in client meetings
  • Facilitate and monitor quality standards for executives
  • Ensure a seamless transition for all new clients within Payer Services functions
  • Address operational and staffing issues promptly and effectively
Read More
Arrow Right

Marine Claims Team Leader

We are looking for a Marine Claims Team Leader to oversee a team of Marine claim...
Location
Location
United States of America , New York; O'Fallon; Chicago
Salary
Salary:
104361.00 - 187548.00 USD / Year
https://www.allianz.com Logo
Allianz
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 7 - 10 years’ experience in specialized understanding of LOB products and portfolio with technical specialist knowledge
  • Management of systems (e.g., WINS, CLAWS, Global Genius)
  • Specialized understanding of regional/local LoB insurance markets and competitor landscape
  • 7 - 10 years’ experience in specialized understanding of insurance related financial mechanisms and KPIs
  • 7 - 10 years’ experience in in-depth understanding of Claims Handling requirements as per internal and regulatory guidelines
  • 7 - 10 years’ experience in understanding of reporting and evaluating Claims data for management purposes
  • Managing people: Ability to lead and manage a team of claim handlers
  • Recognized relationship building with brokers at peer group level and well established within local market
  • Strong understanding of legal and regulatory framework
  • Experience in applying artificial intelligence (AI) and machine learning (ML) to improve business process and decision-making is highly beneficial
Job Responsibility
Job Responsibility
  • Lead and manage Marine Claims Team that handles Marine claims
  • Act as a technical referral point for Claims handlers
  • Ensure claims handled within authority limits, and in line with AzC Claims Standards procedures and guidelines
  • Utilize third party service providers to achieve economical results and to provide a high-quality service to all internal and external customers
  • Develop and maintain strong relationships with brokers and clients
  • Managing a team of Claims Handlers including training and mentoring of staff, managing technical referrals, and supporting Data Quality and Reporting initiatives
  • Oversight of investigations and reserving claims
  • Investigation of claims, including coverage determination and evaluation of loss exposures
  • Determine appropriate reserving levels
  • Oversight of claims processing and administration
What we offer
What we offer
  • Hybrid working model
  • Great compensation and benefits package
  • Annual performance-based cash incentive awards
  • Career development and digital learning programs
  • International career mobility
  • Health and wellbeing benefits including private healthcare and generous parental leave
  • Flexible working
  • Pension scheme
  • Fulltime
Read More
Arrow Right

Ind Manager - Business Service Support

Job Title- IND MANAGER - Business Service support. ARL- 6. Solution Line- WCRG. ...
Location
Location
India , Bengaluru
Salary
Salary:
Not provided
aon.com Logo
Aon
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Graduation or Post Graduation
  • 12+ years of relevant experience
  • 12+ years of Operations Leadership Experience, with Insurance
  • Claims Management Experience
  • Well versed with MS Excel, MS Word
  • Expertise in Understanding, managing and handling Claim documents, ensuring accuracy and compliance
  • Excellent verbal and written communication skills
  • Excellent organizational skills with the ability to manage multiple priorities simultaneously and to deadlines
  • The ability to remain calm under pressure and to work flexibly when required
  • A positive approach and mind-set and excellent attention to detail
Job Responsibility
Job Responsibility
  • Responsible for receiving and reviewing new claims notifications from policyholders, brokers, or other channels
  • Verify claim information and enter details accurately into the claims management system
  • Experience in team management, and ability to lead team of up to 10 or more subject matter experts, ensuring that theirs and own objectives are aligned with the overall business strategy, that performance is satisfactory, and any necessary action is taken to continually to develop capability as future leaders
  • Uphold and demonstrate leadership values and a proven track record of building teams, retaining talent and effective people leadership
  • Building strong relationships with UK colleagues, and other internal stakeholders
  • Should be able to present team performance using data and analytics to drive successful outcomes as well as feedback to ensure effective service delivery of KPIs
  • Manage the service provided to Client Service Delivery based in UK by your team of Business Service Support
  • Monitoring team activity and coordinating workload in line with SLAs by organizing, prioritising, and making effective workload allocation decisions
  • Increasing the level of processing knowledge and driving continuous improvement in all areas of processing
  • Monitor customer feedback and address concerns promptly to ensure satisfaction
What we offer
What we offer
  • Cab Facility
  • Comprehensive benefits package
  • Two “Global Wellbeing Days” each year
  • Variety of workstyle options through Smart Working model
  • Continuous learning culture
  • Fulltime
Read More
Arrow Right

Customer Service Manager

Reporting to the Watchman, the Customer Service Manage will be responsible for t...
Location
Location
United Kingdom , Handy Cross
Salary
Salary:
Not provided
egis-group.com Logo
Egis in the UK
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Customer focused correspondence management
  • Defence of Claims (Insurance) or similar
  • Proven experience in a supervisory or team leadership role within a fast-paced operational environment
  • Working knowledge of National Highways Network Event Management System (NEMS)
  • Excellent communication and interpersonal skills, with the ability to motivate and guide a team
  • High attention to detail and accuracy in data handling and reporting
  • Ability to remain calm and decisive under pressure
  • Proficient in MS Office Suite, including Excel, Word, and SharePoint
  • Strong organisational and time management skills
  • A proactive approach to problem-solving and continuous improvement
Job Responsibility
Job Responsibility
  • Management and processing of all 3rd Party correspondence/Enquiries/Red claim(s) from receipt to closure
  • Manage the NCC Shift Rota to maximise efficiencies and minimisation of costs
  • Manage and support a team of Network Control Operators in delivering their core duties effectively
  • Monitor team performance and ensure compliance with National Highways standards and internal procedures
  • Provide operational oversight during shifts, ensuring incidents, claims, and enquiries are managed promptly and accurately
  • Act as first point of escalation for complex or high-impact incidents, customer enquiries, and abnormal load notifications
  • Coordinate workload requirements to support the 24/7 operational requirements
  • Training, onboarding, and continuous development of team members
  • Review and validate reports, KPIs, and data submissions before escalation to management
  • Ensure timely and accurate booking of Roadspace via NEMS and support planning compliance
Read More
Arrow Right

Marine Claims Technician

Lawes are partnering with a leading global broker to assist with their recruitin...
Location
Location
United Kingdom , London
Salary
Salary:
40000.00 GBP / Year
https://www.lawesrecruitment.co.uk Logo
Lawes Consulting Group
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Experience handling Marine Hull & Liability claims (Yacht claims a plus)
  • Technical expertise in claims presentation for optimal client outcomes
  • Strong negotiation, problem-solving, and decision-making abilities
  • Excellent communication and relationship management skills
  • Knowledge of London market systems (UTIS)
  • Cert CII/Dip CII (preferred)
Job Responsibility
Job Responsibility
  • Manage marine claims from initial advice to settlement
  • Negotiate settlements with clients, Lloyd’s, and Company markets
  • Support Broking Teams in client retention and acquisition
  • Analyse and present claims for optimal results
  • Stay up to date with industry trends and provide risk management insights
  • Fulltime
Read More
Arrow Right