Claims Team Manager

A top-rated Health Administration Company with over 50 years of industry leadership is seeking an experienced Claims Manager to join our growing team. Located in Katy, TX, just off Highway 99 and Westpark Tollway, we’ve been serving our clients since 1970 and remain at the forefront of our industry.

This is an excellent opportunity for a hands-on leader who thrives in a fast-paced environment and is passionate about operational excellence, team development, and process improvement.

The Claims Manager is responsible for the overall direction, coordination, and performance of the Claims Department. This role works closely with cross-functional teams including IT, Account Management, Stop Loss, Customer Service, Medical Help Line, and Sales to ensure accurate, timely claims processing and exceptional client service.

• Lead, coach, and manage the Claims team with a strong on-the-floor presence
• Oversee claims operations including High Dollar Claims, Plan Build, ID Cards, Provider setup, and VBA testing
• Develop and implement strategies to increase auto-adjudicated claims to 50%
• Monitor productivity, quality, and turnaround metrics (30 days for 100% of claims; 14 days for 90%)
• Identify performance trends and implement corrective or improvement initiatives
• Manage claims inventories, work queues, and exception handling
• Resolve complex or escalated claims issues and prevent recurring problems
• Ensure compliance with company policies, contractual standards, and audit requirements
• Recommend and implement workflow, policy, and procedural improvements
• Lead training, cross-training, and onboarding in partnership with HR
• Prepare and present management reports highlighting trends, risks, and recommendations
• Partner with Sales and Account Management to support new client implementations and renewals

• 5 years of supervisory experience and 3 years of management experience in group health claims
• Strong knowledge of commercial health insurance products (HMO, PPO, EPO, HDHP, HRA/HSA)
• Expertise in claims adjudication, eligibility, and benefit determination
• Experience working with stop loss carriers and direct provider agreements
• Knowledge of CPT and ICD-10 coding
• Strong leadership, communication, and team-building skills
• Ability to thrive in a high-volume, fast-paced environment
• Advanced organizational and workflow design skills
• Proficiency in MS Office; VBA experience a plus

✨ Why Join Us?

• Stable, established company with a strong reputation
• Collaborative culture and cross-functional leadership exposure
• Opportunity to make a measurable impact on operations and growth