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Claims Resolution Manager Jobs in New York (NOW HIRING)

C. Winchell Agency, Inc.

Claims Advocate

Parsippany, NJ · On-site

... claims to resolution. Maintain account files in an orderly sequence according to established ... Obtaining Loss Runs. Assist account manager with some processing and sending policies/endorsements ...

Brookfield

Senior Claims Account Manager

New York, NY · On-site

The candidate must also understand that runoff claims management requires a different operating ... Drive runoff outcomes through disciplined claim strategy, accurate reserving, targeted resolution ...

Cna

General Liability Claims Consultant

Tarrytown, NY · Hybrid

$72K - $141K/yr

Makes recommendations on claims processes and resolution strategies to management. * Analyzes claims activities; prepares and presents reports to management and other internal business partners and ...

Cna

General Liability Claims Consultant

Melville, NY · Hybrid

$72K - $141K/yr

Makes recommendations on claims processes and resolution strategies to management. * Analyzes claims activities; prepares and presents reports to management and other internal business partners and ...

Cna

General Liability Claims Consultant

Warren, NJ · Hybrid

$72K - $141K/yr

Makes recommendations on claims processes and resolution strategies to management. * Analyzes claims activities; prepares and presents reports to management and other internal business partners and ...

Related

Claims Associate, Risk Management

Manhattan, NY · On-site

$120K - $140K/yr

Support the end-to-end claims resolution process and track claim status across multiple lines of ... Minimum 4 years of experience in risk management, insurance claims processing, or a related field.

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Claims Resolution Manager information

What does a claims resolution manager do?

A Claims Resolution Manager oversees the process of handling insurance claims from initiation to closure, ensuring that claims are resolved efficiently and fairly. They investigate claim details, coordinate with adjusters, clients, and third parties, and work to resolve disputes or issues that may arise during the claims process. Their goal is to ensure compliance with company policies and legal regulations while optimizing customer satisfaction and minimizing losses for the organization.

What are the primary challenges a claims resolution manager faces when balancing client expectations with policy limitations?

Claims Resolution Managers often navigate the delicate balance between meeting client expectations and adhering to insurance policy terms. One common challenge is communicating complex policy details to clients who may be experiencing stress or frustration. Additionally, managers must ensure timely and fair claims processing while coordinating with adjusters, legal teams, and external vendors. Success in this role requires strong negotiation skills, empathy, and a thorough understanding of regulatory and company guidelines.

What are the key skills and qualifications needed to thrive as a claims resolution manager, and why are they important?

To thrive as a Claims Resolution Manager, you need a solid background in insurance claims processing, dispute resolution, and regulatory compliance, often supported by a bachelor's degree in business, finance, or a related field. Familiarity with claims management software, CRM tools, and relevant certifications such as AIC or CPCU is common. Strong analytical thinking, negotiation skills, and effective communication are crucial soft skills for managing complex cases and guiding teams. These abilities ensure efficient claims handling, customer satisfaction, and minimized financial risk for the organization.

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

AspectClaims Resolution ManagerClaims Adjuster
CredentialsInsurance licenses, sometimes management certificationsInsurance licenses, specific to claims handling
Work EnvironmentSupervisory roles, team coordinationField or office-based, claims investigation
Employer & Industry UsageInsurance companies, claims departmentsInsurance companies, third-party administrators
Search & Comparison IntentUnderstanding managerial roles in claimsDetails about claims handling and investigation

The Claims Resolution Manager oversees claims processes and manages teams, focusing on strategy and resolution. Claims Adjusters handle the investigation and evaluation of individual claims. While both roles require insurance licenses, the manager's role is more supervisory, whereas the adjuster is more hands-on with claims investigation.

What are the most commonly searched types of Claims Resolution jobs in New York?

The most popular types of Claims Resolution jobs in New York are:

What cities in New York are hiring for Claims Resolution Manager jobs?

Cities in New York with the most Claims Resolution Manager job openings:

Claims Resolution Manager jobs near you

Healthcare Claims Resolution Manager

Alteva RCM

New York, NY

$100K - $150K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 8 days ago

Job description

About Us

At Alteva RCM, we're dedicated to helping healthcare providers thrive through expert revenue cycle management, strategic insight, and innovative solutions. We're always looking for passionate, driven professionals who want to make a meaningful impact, grow their careers, and be part of a collaborative team committed to excellence.

Role Overview 

We are seeking an experienced manager to lead our growing Claims Resolution function. This role requires strong management skills, familiarity with healthcare regulatory processes, and the ability to navigate the interaction between multiple layers of regulatory requirements as they relate to healthcare reimbursement, dispute resolution, and revenue cycle operations. 

The ideal candidate can research, interpret, and apply jurisdiction-specific requirements in a fast-moving environment, and translate complex regulatory information into clear, practical guidance for operational teams. 

The Manager will lead team members and team leads, maintain workflow efficiency, ensure deadlines and quality standards are met, and help the department scale in an organized, effective manner. 

Key Responsibilities 

  • Manage daily operations of the Claims Resolution function, ensuring work is completed accurately, efficiently, and on schedule. 
  • Oversee team leads and team members, providing direction, accountability, coaching, and support. 
  • Develop and maintain workflows, reporting structures, and internal processes to support department growth. 
  • Monitor team performance and identify opportunities to improve productivity, quality, consistency, and regulatory compliance. 
  • Maintain a strong working knowledge of relevant healthcare regulations, rules, and procedural requirements across multiple jurisdictions. 
  • Understand the distinctions, overlap, and potential conflicts between different regulatory frameworks as they relate to healthcare claims and reimbursement disputes. 
  • Evaluate which procedural framework applies to a given claim or dispute, and ensure operational procedures reflect the correct process. 
  • Research jurisdiction-specific requirements as needed and translate findings into operational guidance, workflows, and training materials. 
  • Monitor relevant regulatory developments and assess their operational impact. 
  • Coordinate with senior leadership on department performance, staffing, workflow challenges, and strategic priorities. 
  • Partner with legal, compliance, and revenue cycle teams on complex or overlapping regulatory questions. 

Requirements 

  • Proven managerial experience, preferably overseeing multiple team members or team leads. 
  • Ability to manage a fast-paced, high-volume department with strong attention to deadlines and detail. 
  • Strong research and analytical skills; ability to interpret and apply regulations and procedural requirements. 
  • Familiarity with regulatory frameworks affecting healthcare reimbursement, claims processing, and dispute resolution. 
  • Ability to translate regulatory concepts into clear operational procedures. 
  • Excellent communication, leadership, and organizational skills. 
  • Experience in dispute resolution, legal operations, healthcare compliance, health insurance, revenue cycle management, medical billing, or another regulated healthcare environment strongly preferred. 

Shift Requirements 

Must be able to work a flexible schedule to coordinate with distributed team members across time zones, including some overlap with international team members and availability for leadership check-ins later in the workday, Eastern Time.

Pay Range
$100,000—$150,000 USD

Benefits

Alteva RCM offers our employees a comprehensive benefits package, including health, dental, vision, employee assistance plan, paid family leave, short-term disability and life insurance. We also provide a 401(k) plan with employer match, flexible spending accounts, employee discount program and an employee referral program.

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