Claims Manager

Claims Manager
Location – Madison, CT and Rye Brook, NY
Type – Permanent
Payrate – Starting salary $70,000.00 - $110,000.00
Schedule – Monday – Friday 8:30am – 5:00pm
We are seeking a highly skilled and detail-oriented Claims Manager to oversee and coordinate the claims process within our organization. The ideal candidate will possess strong analytical, organizational, and negotiation skills, with a comprehensive understanding of insurance policies, medical documentation, auto and property claims, and risk management. This role involves managing a team of claims adjusters and collaborating with various departments to ensure efficient claims resolution while maintaining compliance with industry standards and regulations. The Claims Manager will play a critical role in fraud prevention, risk analysis, and service writing to optimize claim outcomes and customer satisfaction.
Duties

• Lead and supervise the claims department, ensuring timely and accurate processing of claims across multiple lines including workers' compensation, auto insurance, medical billing, and property damage.
• Oversee the review and evaluation of insurance claims, utilizing analysis skills to assess damages, coverage eligibility, and liability.
• Coordinate with underwriters to evaluate risk factors and determine appropriate claim settlements.
• Implement fraud prevention and detection strategies to identify suspicious claims activities.
• Conduct negotiations with claimants, attorneys, repair shops, healthcare providers, and other stakeholders to reach fair resolutions.
• Manage auto estimating processes, auto service management, auto body repair coordination, water damage restoration assessments, mold remediation evaluations, construction inspection reports, and automotive repair claims.
• Ensure compliance with medical coding standards such as ICD-9/10, CPT coding, HCPCS, ICD coding for medical records and Medicare claims.
• Maintain accurate documentation within medical records systems while adhering to medical terminology standards.
• Utilize financial software for claim processing and reporting purposes.
• Develop risk management strategies to minimize losses while providing excellent customer service.
• Prepare detailed service writing reports for complex claims involving auto restoration or water damage repairs.
• Monitor industry regulations related to insurance verification, ICD coding updates, HCPCS changes, and other compliance requirements.

Skills

• Strong negotiation skills for effective settlement discussions.
• Expertise in underwriting principles related to various insurance lines including workers' compensation.
• Knowledge of fraud prevention techniques within insurance claims processing.
• Proficiency in risk analysis to evaluate potential liabilities accurately.
• Experience with auto estimating tools and auto service management systems.
• Familiarity with auto body repair processes and automotive repair standards.
• Ability to interpret medical documentation using medical terminology along with ICD-9/10 codes for accurate medical billing and coding.
• Organizational skills necessary for managing multiple claims simultaneously while maintaining detailed records.
• Analytical skills for assessing damages across different claim types such as water damage restoration or mold remediation projects.
• Experience with construction inspection reports related to property damage claims.
• Knowledge of insurance verification procedures and compliance standards in the industry. This position offers an engaging opportunity for professionals experienced in insurance claim management who are committed to excellence in customer service while ensuring regulatory compliance across diverse claim types including workers' compensation, automotive repairs, medical billing, and property restoration projects.