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.
Equal Opportunity Notice

Highspring LLC (d/b/a Vaco by Highspring) and its parents, affiliates, and subsidiaries ("we," "our," or "Vaco by Highspring") are committed to the full inclusion of all qualified individuals and does not discriminate against any employee or applicant for employment because of race (including but not limited to traits historically associated with race such as hair texture and hair style), color, sex (includes pregnancy or related conditions), religion or creed, national origin, citizenship, age, disability, status as a veteran, union membership, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, political affiliation, or any other protected characteristics as required by applicable law. The company is also committed to ensuring that persons who need them are provided with reasonable accommodations; if an accommodation is needed to participate in the job application or interview process, please contact HR@vaco.com .

Vaco by Highspring also wants all applicants to know their rights that workplace discrimination is illegal.

Representation Notice

By submitting to this position, you agree that you will be giving Vaco by Highspring the exclusive right to present your as a candidate for the foregoing employment opportunity. Additionally, you agree to be included in our talent pool for future hiring for similarly qualified positions. You further agree that you have represented information about yourself accurately and have not affirmatively misrepresented your qualifications. Lastly, you agree to maintain as confidential, to the fullest extent permitted by law, any information you learn from Vaco by Highspring about the position and you will limit disclosure of information about the position only to the extent necessary to perform any obligations in furtherance of your application. In exchange, Vaco by Highspring agrees to exercise reasonable efforts to represent you through all solicitation, job screening and resume dispersal.

For residents of Ontario, Canada only: to the extent the position for employment is not with Highspring or not otherwise noted as vacant above, candidate should be informed that this role is to replace a presently employed person at Vaco by Highspring's client.

Privacy Notice

Vaco by Highspring respects your privacy and are committed to providing transparent notice of our policies.

• California residents may access Vaco by Highspring HR Notice at Collection for California Applicants and Employees here.


• Virginia residents may access our state specific policies here.


• Residents of all other states may access our policies here.


• Canadian residents may access our policies in English here and in French here.


• Residents of countries governed by GDPR and UK GDPR may access our policies here.

Additionally, 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. More details about Vaco by Highspring's use of AI can be found here (https://www.highspring.com/ai-use-notices/). Further assessment of candidates beyond this initial phase will be conducted by recruiters and hiring managers. Vaco by Highspring does not know and cannot opine on if its client's use of AI products in hiring.

Pay Transparency Notice

Determining compensation for this role (and others) at Vaco by Highspring depends upon a wide array of factors including but not limited to:

· the individual's skill sets, experience and training;

· licensure and certification requirements;

· office location and other geographic considerations; and

· other business and organizational needs.

With that said, as required by local law, Vaco by Highspring believes that the following salary range referenced above reasonably estimates the base compensation for an individual hired into this position in geographies that require salary range disclosure. The individual may also be eligible for discretionary bonuses and/or participation in medical, dental, and vision benefits as well as the company's retirement plan (or similar retirement benefits).