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Claims Administration Manager Jobs in Michigan (NOW HIRING)

Sedgwick

Claims Representative , Auto

Detroit, MI · On-site

$50K/yr

Management retains the discretion to add or to change the duties of the position at any time As ... Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive ...

Sedgwick

Claims Representative , Auto

Lansing, MI · On-site

$50K/yr

Management retains the discretion to add or to change the duties of the position at any time As ... Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive ...

Sedgwick

Claims Representative , Auto

Grand Rapids, MI · On-site

$50K/yr

Management retains the discretion to add or to change the duties of the position at any time As ... Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive ...

Sedgwick

Office Assistant

Bay City, MI · On-site

$14 - $18.25/hr

Management retains the discretion to add or to change the duties of the position at any time ... Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive ...

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Claims Administration Manager information

What does a claims administration manager do?

A Claims Administration Manager oversees the processing and management of insurance claims within an organization. They ensure that claims are handled efficiently, accurately, and in compliance with company policies and legal regulations. Their responsibilities often include supervising claims staff, developing procedures to improve workflow, resolving complex claims issues, and liaising with clients or policyholders. This role requires strong leadership, problem-solving skills, and a thorough understanding of insurance processes.

What are the key skills and qualifications needed to thrive as a claims administration manager?

To thrive as a Claims Administration Manager, you need expertise in claims processing, risk assessment, and regulatory compliance, typically supported by a bachelor's degree in business, finance, or a related field. Familiarity with claims management software, data analytics tools, and industry certifications such as AIC (Associate in Claims) are commonly required. Strong leadership, problem-solving, and interpersonal communication skills help manage teams and resolve complex claims issues. These abilities ensure efficient claims operations, regulatory adherence, and high-quality service for clients and stakeholders.

What are some common challenges faced by claims administration managers and how can they be addressed?

Claims Administration Managers often face challenges such as managing high volumes of claims, ensuring compliance with evolving regulations, and coordinating effectively between internal teams and external partners. Addressing these challenges requires strong organizational and communication skills, as well as the implementation of efficient workflows and regular staff training. Leveraging technology for claims processing and maintaining open lines of communication can help streamline operations and minimize errors, ultimately improving both team performance and customer satisfaction.

What is the difference between Claims Administration Manager vs Claims Adjuster?

AspectClaims Administration ManagerClaims Adjuster
CredentialsTypically requires a bachelor’s degree in insurance, business, or related field; certifications like CPCU or ARM are commonRequires a high school diploma or equivalent; some roles prefer certifications like CPCU or state licensing
Work EnvironmentOversees claims teams, manages processes, and develops policies within insurance companies or third-party administratorsInvestigates and evaluates individual claims, often working in the field or office to determine coverage and settlement
Employer & Industry UsageUsed in insurance companies, third-party administrators, and corporate claims departmentsCommonly employed by insurance carriers, adjusting firms, and independent agencies

The Claims Administration Manager focuses on overseeing claims processes and managing teams, while the Claims Adjuster handles the investigation and evaluation of individual claims. Both roles require insurance knowledge, but the manager position involves more leadership and policy development, whereas the adjuster role is more hands-on with claim assessment.

What are popular job titles related to Claims Administration Manager jobs in Michigan?

For Claims Administration Manager jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Claims Administration Manager jobs in Michigan look for?

The top searched job categories for Claims Administration Manager jobs in Michigan are:

Claims Administration Manager jobs near you

Director Claims Administration

Corewell Health

Grand Rapids, MI • On-site

Full-time

Medical, Retirement

Re-posted 8 days ago

Corewell Health rating

7.0

Company rating: 7.0 out of 10

Based on 778 frontline employees who took The Breakroom Quiz

414th of 893 rated healthcare providers

Job description

Job Summary - Director, Claims Administration
The Director of Claims Administration is responsible for the accurate, timely and efficient adjudication and payment of claims for all product lines at Priority Health. The leader is accountable for claim inventory, claim speed to process, claim auto adjudication rate, claim examiner quality scores, coordination of benefits savings, and third party liability savings.
Essential Functions - Director, Claims Administration
  • Lead and develop a high performing claims adjudication team. Assure proper staffing levels.
  • Implement goals setting, monitoring and achieving service-levels, medical trend management savings, and unit costs.
  • Ensure functions to meet or exceed corporate standards for accuracy and timeliness of claim payment.
  • Foster and maintain relationships with other departments to ensure that claims processes and procedures efficiently support other departments, products and overall customer service. Service on corporate committees as directed.
  • Initiate process improvement and cost-saving measures. Foster an environment that allows for continuous improvement.
  • Develop multi-year roadmaps and meet targets for unit costs, service levels, coaching and development, and other goals as developed.
  • Effectively communicate issues and concerns through verbal and written communications. Effectively communicate operational issues and concerns to leadership.
  • Ensure compliance with state and federal rules and regulations such as HIPAA, Department of Labor, ERISA, Michigan HMO Legislation, Medicaid, MiChild and Medicare.

Qualifications - Director, Claims Administration
  • Required Bachelor's Degree or equivalent education and experience

  • 10 years of relevant experience Prior management experience Required
  • 2 years of relevant experience Prior claims administration management experience Preferred
  • Health care plan claims experience strongly preferred.

Physical Demands - Director, Claims Administration
  • Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs

  • Waist to Waist > 5 lbs: Seldom up to 10 lbs
  • Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
  • Waist to Overhead > 5 lbs: Seldom up to 10 lbs
  • Bilateral Carry > 5 lbs: Seldom up to 10 lbs
  • Unilateral Carry > 5 lbs: Seldom up to 10 lbs
  • Pushing Force > 5 lbs: Seldom up to 10 lbs
  • Pulling Force > 5 lbs: Seldom up to 10 lbs
  • Sitting: Frequently
  • Standing: Occasionally
  • Walking: Occasionally
  • Forward Bend - Standing: Seldom
  • Forward Bend - Sitting: Occasionally
  • Trunk Rotation - Standing: Seldom
  • Trunk Rotation - Sitting: Occasionally
  • Reach - Above Shoulder: Seldom
  • Reach - at Shoulder or Below: Seldom
  • Handling: Occasionally
  • Forceful Grip > 5 lbs: Seldom
  • Forceful Pinch > 2 lbs: Seldom
  • Finger/Hand Dexterity: Frequently

How Corewell Health cares for you
  • Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
  • On-demand pay program powered by Payactiv
  • Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
  • Optional identity theft protection, home and auto insurance
  • Traditional and Roth retirement options with service contribution and match savings
  • Eligibility for benefits is determined by employment type and status

Primary Location
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Department Name
Quality and Payment Integrity Administration - PH Managed Benefits
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
9:00 a.m. to 5:00 p.m.
Days Worked
Monday through Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.

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