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Claims Risk Manager Jobs in New York (NOW HIRING)

Atlantic Health System

Risk Manager

Morristown, NJ · On-site

$61.18 - $107.69/hr

Reviews events and identifies potential claims/lawsuits * Prepares potential files, documenting ... risk management, corporate compliance, EMTALA, HIPAA and other regulatory concerns following the ...

Atlantic Health System

Risk Manager

Morristown, NJ · On-site

Reviews events and identifies potential claims/lawsuits * Prepares potential files, documenting ... risk management, corporate compliance, EMTALA, HIPAA and other regulatory concerns following the ...

The HR Source

Senior Risk Manager

New York, NY

We are seeking a seasoned Risk Management Consultant with a deep background in construction-related ... Maintain and improve systems used for tracking policies, claims, and compliance metrics. Review ...

AIG

Insurance Risk Manager

New York, NY

Corporate Insurance Department also delivers evidence of insurance, advice and consultation on specific insurance programs, evaluation of risk with mapping to insurance and claims management. AIG ...

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Manager, Risk Management

Manhattan, NY · On-site

$125K - $160K/yr

Responsibilities The Construction Risk Manager will support the Company's risk management programs ... and claims data * Maintain program documentation for Controlled Insurance Programs * Prepare ...

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Manager, Risk Management

Manhattan, NY · On-site

$125K - $160K/yr

Responsibilities The Construction Risk Manager will support the Company's risk management programs ... and claims data * Maintain program documentation for Controlled Insurance Programs * Prepare ...

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Claims Associate, Risk Management

Manhattan, NY · On-site

$120K - $140K/yr

Minimum 4 years of experience in risk management, insurance claims processing, or a related field. * Solid understanding of insurance policies, claims procedures, and terminology across multiple ...

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Claims Risk Manager information

How does a Claims Risk Manager typically collaborate with other departments to minimize organizational risk?

A Claims Risk Manager works closely with departments such as underwriting, legal, compliance, and operations to identify potential risk exposures and implement effective mitigation strategies. They often participate in cross-functional meetings to review claims trends, share insights, and develop risk management policies. This collaborative approach ensures that the organization proactively addresses risks, maintains regulatory compliance, and continually improves claims processes for better outcomes.

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

AspectClaims Risk ManagerClaims Adjuster
CredentialsTypically requires a bachelor’s degree in risk management, insurance, or related field; certifications like CPCU or ARM are commonRequires a high school diploma or bachelor’s degree; insurance licenses may be needed depending on state
Work EnvironmentOffice-based, strategic planning, risk assessment, policy developmentField or office-based, investigating claims, assessing damages, negotiating settlements
Industry UsageUsed across insurance companies, risk management firms, and large corporationsPrimarily in insurance companies, adjusting claims for auto, property, or health insurance

The Claims Risk Manager focuses on identifying and mitigating risks related to claims, developing policies, and overseeing risk strategies. In contrast, a Claims Adjuster handles the day-to-day investigation and settlement of individual claims. Both roles are essential in the insurance industry but differ in scope and responsibilities.

What are the key skills and qualifications needed to thrive as a Claims Risk Manager, and why are they important?

To thrive as a Claims Risk Manager, you need expertise in insurance claims processes, risk assessment, and regulatory compliance, typically backed by a bachelor’s degree in a relevant field and experience in claims management. Familiarity with claims management systems, risk modeling software, and certifications such as CPCU (Chartered Property Casualty Underwriter) or ARM (Associate in Risk Management) are often required. Strong analytical thinking, attention to detail, and effective communication skills help you investigate claims and collaborate with stakeholders. These skills enable accurate risk evaluation, minimize losses, and ensure the organization’s compliance and financial stability.

What does a Claims Risk Manager do?

A Claims Risk Manager is responsible for identifying, assessing, and managing risks associated with insurance claims within an organization. They analyze claims data to detect patterns, prevent fraudulent activity, and develop strategies to minimize financial losses. Additionally, they work closely with claims adjusters, legal teams, and other departments to ensure compliance with regulations and to optimize claims processes. Their goal is to protect the company from unnecessary losses while ensuring legitimate claims are handled efficiently.
What are popular job titles related to Claims Risk Manager jobs in New York? For Claims Risk Manager jobs in New York, the most frequently searched job titles are:
What job categories do people searching Claims Risk Manager jobs in New York look for? The top searched job categories for Claims Risk Manager jobs in New York are:
What cities in New York are hiring for Claims Risk Manager jobs? Cities in New York with the most Claims Risk Manager job openings:
Claims Risk Manager jobs near you
Risk Manager

Risk Manager

Atlantic Health System

Morristown, NJ • On-site

$61.18 - $107.69/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 17 days ago

Atlantic Health System rating

8.0

Company rating: 8.0 out of 10

Based on 275 frontline employees who took The Breakroom Quiz

88th of 886 rated healthcare providers

Job description


The Risk Manager is responsible for the review and evaluation of events entered into the Atlantic Health reporting system, and to identify potential claims, lawsuits, and reportability under the Patient Safety Act. Refers events to Peer Review, Quality & Outcomes Management and other committees to address as appropriate. Organizes and moderates Root Cause Analysis and assists with the development of corrective action plans. Coordinates and facilitates regulatory investigations and responds as needed. Management of the resolution process related to complaint/grievances. Provides education to nursing, medical residency staff and all ancillary departments as needed. Manages translation services
  • Evaluates event for severity, frequency and probability of financial loss
  • Reports as appropriate to administration and committees
  • Responds to significant events; review facts; review medical record/documentation; preserve any evidence; conduct staff interviews
  • Provides recommendations for staff re: investigation/handling of events to appropriate management, administrators
  • Refers to Peer Review, Care Review, and Quality & Outcomes Management Committees to address as appropriate
  • Develop educational programs as appropriate or needed based on event findings and trends
  • Reviews events and identifies potential claims/lawsuits
  • Prepares potential files, documenting factual investigation of event
  • Communicates findings to the legal team as appropriate for case preparation
  • Reviews incidents and determines reportability as a Serious Preventable Event under the Patient Safety Act
  • Conducts initial team huddle and determines next steps along with Executive Sponsorship
  • Submits initial notification of SPE to DHSS
  • Organizes and moderates Root Cause Analysis meeting with health care providers involved to identify causal and contributing factors to the event, and assists with development of a corrective action plan
  • Coordinates case presentations to Preventable Events Review Committee
  • Advises site nursing staff, medical staff and administration on legal issues, billing, insurance, risk management, corporate compliance, EMTALA, HIPAA and other regulatory concerns following the review of regulations and standards.
  • Addresses clinical queries by reviewing applicable policies and aligning responses with identified clinical needs
  • Serves as a resource for all inquiries, fostering ongoing open communication and engagement
  • Delivers targeted education and in service training to nursing , medical , and residency staff, as requested or informed by needs identified through case review and event reporting trends
  • Topics include litigation process, documentation, event management, hospital policies, protocols
  • Triages events, escalate, investigates and refers as appropriate, close events
  • Acknowledges clinical staff for Good Catches
  • Provide training to nursing staff, medical staff, and residency staff on use of program
  • Coordinate and facilitate investigations (DHSS)(FDA) (CMS)
  • Facilitate, prepare and submit material to agency and respond to deficiencies
  • Coordinate voluntary and required reporting to the FDA
  • Proactive management of difficult patients and family members of complex care cases to mitigate complaints
  • Liaison between patient/family and nursing/physician teams to resolve concerns
  • Manage the response process as well as the electronic documentation of all clinical complaints/grievances in the database
  • Track and trend patterns of complaints/grievances and reports to leadership
  • Ensure compliance with DOH/CMS regulations regarding clinical patient complaints/grievances
  • Manage and arrange language translation services for patients and families while ensuring compliance with regulations
  • Provide training to teams on language translation services as needed

Qualifications
Required:
• Bachelor's degree in Healthcare or related field preferred.
• Minimum 7 years of Risk Management experience preferred
• Minimum 3 years in Healthcare work experience required
• Must pass a Level II Background Check
Required Licenses, Certifications or Registrations:
  • RN or other clinical professional license
  • CPHRM within two years of hire

About Us
At Atlantic Health, our promise to our communities is; Anyone who enters one of our facilities will receive the highest quality care delivered at the right time, at the right place, and at the right cost. This commitment is also echoed in the respect, development and opportunities we give to our more than 22,000 team members. Headquarters in Morristown, New Jersey, we are one of the leading non-profit health care systems in the nation. Our facilities and sites of care include:
  • Atlantic Health Morristown Medical Center, Morristown, NJ
  • Atlantic Health Overlook Medical Center, Summit, NJ
  • Atlantic Health Newton Medical Center, Newton, NJ
  • Atlantic Health Chilton Medical Center, Pompton Plains, NJ
  • Atlantic Health Hackettstown Medical Center, Hackettstown, NJ
  • Atlantic Health Goryeb Children's Hospital, Morristown, NJ
  • Atlantic Health CentraState Healthcare System, Freehold, NJ
  • Atlantic Medical Group
  • Atlantic Visiting Nurse
  • Atlantic Mobile Health
  • Atlantic Rehabilitation

We have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group.
We have received awards and recognition for the services we have provided to our patients, team members and communities. Below are just a few of our accolades:
  • Chosen for 17 years by Fortune as one of the magazine's "100 Best Companies to Work For."
  • Atlantic Health Morristown and Atlantic Health Overlook Named by Newsweek as two of the "World's Best Hospitals" in 2026.
  • Atlantic Health Morristown and Atlantic Health Overlook ranked within the top three hospitals in New Jersey by U.S. News & World Report's 2025-2026 Best Hospital rankings.
  • Atlantic Health scored four "A" grades by The Leapfrog Group in its Fall 2025 Hospital Safety Grades, performance measures reflecting errors, accidents, injuries and injections, as well as systems hospitals have in place to prevent harm.
  • Atlantic Health Morristown and Atlantic Health Overlook are New Jersey's only hospitals to be named among America's 50 Best hospitals by Healthgrades in 2026.
  • Named by Becker's Healthcare as one of the "165 Top Places to Work in Healthcare - 2026.
  • Atlantic Health Morristown, Atlantic Health Overlook, Atlantic Health Chilton and Atlantic Health Newton all Forbes Top Hospitals for 2026.
  • Named by Newsweek as one of America's Greatest Workplaces for Inclusion & Diversity 2025.
  • Atlantic Health rated LEVEL 9 - 2025 CHIME Digital Health Most Wired.

Atlantic Health offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members. Offerings vary based on role level (Team Member, Director, Executive). Below is a general summary, with role-specific enhancements highlighted:
Team Member Benefits
  • Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members)
  • Life & AD&D Insurance.
  • Short-Term and Long-Term Disability (with options to supplement)
  • 403(b) Retirement Plan: Employer match, additional non-elective contribution
  • PTO & Paid Sick Leave
  • Tuition Assistance, Advancement & Academic Advising
  • Parental, Adoption, Surrogacy Leave
  • Backup and On-Site Childcare
  • Well-Being Rewards
  • Employee Assistance Program (EAP)
  • Fertility Benefits, Healthy Pregnancy Program
  • Flexible Spending & Commuter Accounts
  • Pet, Home & Auto, Identity Theft and Legal Insurance

Note: In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits. Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer.
EEO STATEMENT
Atlantic Health, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran
About the Team
Atlantic Health System is at the forefront of medicine, setting standards for quality health care powered by a workforce of more than 18,000 team members and 4,800 affiliated physicians dedicated to building healthier communities, the system offers more than 400 sites of care, including eight award-winning medical centers. Specializing in cardiovascular care, cancer care, orthopedics, neuroscience, pediatrics, women's health and rehabilitation medicine. Atlantic Medical Group, comprised of 1,000 physicians and advanced practice providers, represents one of the largest multi-specialty practices in New Jersey and includes finance, legal, marketing, human resources, talent acquisition, ISS and more. Caring for our patients, our team members and the communities we serve is our central mission.

What Atlantic Health System employees say

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About Atlantic Health System

Sourced by ZipRecruiter

Atlantic Health System aims to deliver the highest quality, safety and care combined the best experience for our patients and their families. We are confident that you will find success within Atlantic Health System, which has been named for the 14th year in a row to Fortune's "Top 100 Best U.S. Companies to Work For" list. We believe you will find that our culture of collaboration and care exemplifies the value we place on our patients, their families and our employees.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Morristown, NJ, US

Year founded

1996

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