Claims Processing Manager

JOB OVERVIEW :
Reporting to the Regional Claims Manager, the Claims Manager holds a senior leadership role responsible for the comprehensive management, operational performance, and strategic direction of the regional health claims unit. This position thrives in an agile, multitasking office environment and serves as a crucial operational link between Global/Regional Management and the local processing team. The Claims Manager is fully accountable for driving team productivity, developing departmental strategies, preparing executive metric reports, and overseeing complex or high-value adjudications. Demonstrating high adaptability, this leader extends beyond traditional claims functions to coordinate cross-functional activities, optimize local workflows, and ensure service delivery consistently exceeds client and stakeholder expectations.

 

KEY RESPONSIBILITIES
Responsibilities include, but are not limited to:
• Leading a team of claims adjusters to achieve departmental KPIs aligned with organizational goals.
• Acting as a liaison between Global Management and the claims team to ensure clear communication and alignment of objectives.
• Developing and implementing departmental strategies and goals.
• Providing regular updates and reports to Regional Management on team performance, claims processing, and customer satisfaction.
• Participating in strategic planning with clear decision-making processes.
• Offering guidance, training, and mentorship to team members to enhance skills and performance.
• Monitoring team workload and ensuring equitable task distribution.
• Reviewing complex or escalated claims and advising on claim determinations.
• Resolving escalated customer inquiries and complaints regarding claims.
• Analyzing claims data and performance metrics to identify trends and opportunities for process improvement.
• Preparing and presenting reports on claims activities, outcomes, and key performance indicators (KPIs) to senior management.
• Utilizing data analysis to drive strategic decisions and optimize claims processes.
• Actively engaging in operational activities beyond claims to ensure coordinated service delivery that meets and surpasses client expectations.
• Assisting in developing and updating claims policies and procedures.
• Ensuring team compliance with all regulatory and company guidelines.
• Preparing and presenting regular reports on claims activity, performance metrics, and trends.
• Analyzing data to identify improvement areas and implementing corrective actions.
• Performing other ad hoc duties as required.

REQUIREMENTS
To excel in this role, you should possess the following skills and experience:
• Bachelor’s degree in Medical/Paramedical fields, Finance, Business Administration, Insurance, or a closely related operational discipline is preferred.
• Minimum of 8 years of progressive, hands-on experience in claims management, third-party administration (TPA), or health insurance operations.
• At least 4 years in a supervisory, leadership, or management role with a proven track record of effectively managing teams and achieving complex operational objectives.
• Strong analytical skills with the ability to interpret complex data, identify trends, detect inefficiencies, and make confident, data-driven decisions.
• Detail-oriented with excellent organizational, project management, and time management capabilities, adept at handling multiple priorities in a fast-paced environment.
• Proficiency in claims management software and Microsoft Office Suite.
• Flexibility to adapt to evolving business needs and perform well under pressure.
• Hybrid working options available in line with business requirements and regional policies.
• Legal authorization to work in the country of operations.
Desirable
• 8 to 10 years of total experience in healthcare, insurance, or TPA industries.
• Experience with process optimization methodologies such as Lean, Six Sigma, or Agile operational tracking is advantageous.
• Fluency in English, both written and verbal.
Personal Attributes
• Thinks globally while executing locally, effectively translating performance metrics and data trends into sustainable organizational success.
• Balances strategic thinking with practical execution.
• Confident communicator and facilitator, skilled at building trust across diverse stakeholder groups.
• Collaborative and resilient, thriving in dynamic, global environments.