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Claims Administration Manager

Job Summary:

The Claims Administration Manager will be responsible for the overall operational leadership of the claims organization.  This role will also play an active role in the establishment of the organization, working closely with project teams responsible for the development and continued enhancement of the claims processing technical platform.

Job Description:

Primary Responsibilities (Include duties that represent 5% or more of employee’s time)

  • Propose initiatives that support the strategic objectives of the larger organization, identifying short and longer-term requirements.
  • Conduct/Oversee studies or analysis to determine feasibility and costs of initiatives.
  • Determine long-term resources (systems, skills needed, capacity planning, etc.) to meet future business needs.
  • Participate in cost/benefit analysis of operational changes in support of future business requirements.
  • Regularly track group/departmental costs, ensuring these are managed within budget. Employ cost containment measures while retaining quality and efficient operations and a productive, healthy work environment.  Anticipate expenses and identify potential budgetary concerns to Vice President of Claims and Configuration.
  • Regularly analyze and report on the productivity and effectiveness of the operations in comparison to established performance metrics.  Identify areas of improvement and recommend resolution.
  • Work cross-functionally to ensure operations and changes are well integrated.
  • Proactively seek feedback from other groups on the impact and effectiveness of current and changes to operations.
  • Implement, manage and refine business processes required to deliver expected business results.
  • Implement short-term staffing plans to ensure anticipated operational requirements are met. Monitor the workload and adjust staff assignments accordingly.
  • Ensure team has appropriate resources and highlights areas of need to Vice President for resolution.
  • Ensure the timely and accurate exchange of information/data with relevant stakeholders of the operation.
  • Monitor the work environment and the business operation.  Address concerns that may affect the morale and/or operational effectiveness of the group.
  • Oversee managers and their role in developing and managing staff.
  • Ensure objectives defined across a broader group are integrated and supportive where necessary.
  • Define roles and accountabilities for staff, within the group and in the context of the broader process/operation in support of cross-functional efforts.
  • Hire for, develop and recognize the experience and knowledge/skills/abilities required for a successful team.
  • Provide for the orientation and welcome of new staff.
  • Define performance expectations and goals for staff.
  • Train and mentor staff on the application of policy and procedures, use of supporting systems/applications, appropriate soft skills: time management, etc.
  • Monitor work of individual staff for efficiency, effectiveness and quality.  Provide ongoing constructive feedback and guidance to staff.
  • Evaluate staff on achievement of goals and deliverables and assessment of competencies.  Help staff progress in their careers to the benefit of the department and broader organization.  Manage the resolution of performance issues in consultation with Human Resources as appropriate.
  • Proactively communicate with other departments to ensure cross-functional concerns are identified and effectively addressed.
  • Establish and maintain an open communication channel with staff.
  • Monitor effectiveness of communication with other groups (internal and external). Collaborates with Vice President to implement changes as necessary to ensure an open, productive exchange of information.
  • Represent the department as requested.
  • Keep abreast of relevant regulatory (pending and potential) updates. Identify and plan for potential impact to operations.
  • Ensure relevant changes to operations and/or contractual requirements can be supported.
  • Ensure operational compliance with all relevant regulatory agencies.
  • Ensure operations meet vendor/customer contractual requirements.
  • Keep abreast of changes in requirements.
  • Proactively identify areas of concern or exceptions and promptly notify stakeholders
  • Serve as a subject matter expert and provide peer support in a mentoring or collaborative capacity in the office environment, whether it be training or answering of questions, as deemed appropriate by management.

Working Conditions

  • While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer: The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands, and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.


Claims Administration Manager

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