Claims Manager

Job Overview:

Our client is seeking a Claims Manager to lead and strengthen a growing claims operations department within a privately held benefits and insurance administration organization. This fully on?site leader will oversee all aspects of claims processing, quality, workflow optimization, and vendor coordination. The ideal candidate brings strong operational ownership, the ability to work hands?on when needed, and a focus on accuracy, compliance, and continuous improvement.

Key Responsibilities:

• Oversee day?to?day claims operations ensuring timely, accurate adjudication across all claim types.
• Set performance expectations, manage workflows, and ensure alignment with service-level standards.
• Strengthen quality controls, audit programs, operational policies, and procedural documentation.
• Review and approve high?dollar claims and ensure adherence to policy guidelines and regulatory compliance.
• Manage vendor relationships including networks, repricing partners, and clearinghouses.
• Collaborate with cross?functional teams to resolve escalations and improve operational efficiency.
• Support product development, system updates, and contribute to RFP and proposal processes.

Qualifications:

• 5–7 years of experience leading claims operations in insurance or benefits administration.
• TPA experience required.
• Proven experience managing claim workflows, KPIs, and continuous improvement initiatives.
• Background working with automated claims adjudication systems.
• Experience in network repricing, reference?based pricing, and cost?containment processes.
• Strong communication, analytical, and organizational skills.
• Bachelor’s degree preferred.

Workstyle:

• Fully on-site in Clearwater, FL

Determining compensation for this role (and others) at Vaco/Highspring depends upon a wide array of factors including but not limited to the individual's skill sets, experience and training, licensure and certifications, office location and other geographic considerations, as well as other business and organizational needs. With that said, as required by local law in geographies that require salary range disclosure, Vaco/Highspring notes the salary range for the role is noted in this job posting. The individual may also be eligible for discretionary bonuses, and can participate in medical, dental, and vision benefits as well as the company's 401(k) retirement plan.

Additional disclaimer: Unless otherwise noted in the job description, the position Vaco/Highspring is filing for is occupied. Please note, however, that Vaco/Highspring is regularly asked to provide talent to other organizations. By submitting to this position, you are agreeing to be included in our talent pool for future hiring for similarly qualified positions.

Submissions to this position are subject to the use of AI to perform preliminary candidate screenings, focused on ensuring minimum job requirements noted in the position are satisfied. Further assessment of candidates beyond this initial phase within Vaco/Highspring will be otherwise assessed by recruiters and hiring managers. Vaco/Highspring does not have knowledge of the tools used by its clients in making final hiring decisions and cannot opine on their use of AI products.