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Claims Unit Manager Jobs in Lexington, SC (NOW HIRING)

CEI

RN/Managed Care Coordinator - Remote

Columbia, SC · Remote

Must have experience in one of the following - Critical Care, ICU, ER, Cardiac PACU, Progressive ... Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare ...

CEI

RN/Managed Care Coordinator - Remote

Columbia, SC · Remote

Must have experience in one of the following - Critical Care, ICU, ER, Cardiac PACU, Progressive ... Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare ...

Pwc

Duck Creek Application Architect, Manager

Columbia, SC · On-site

$99K - $232K/yr

... claims preferred - Knowledge of P&C Insurance domain (Policy, Claims, and Billing applications ... unit tests for testing business logic Travel Requirements Up to 60% Job Posting End Date The salary ...

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Claims Unit Manager information

See Lexington, SC salary details

$30K

$75.2K

$119K

How much do claims unit manager jobs pay per year?

As of Aug 28, 2026, the average yearly pay for claims unit manager in Lexington, SC is $75,205.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,200.00 and $89,900.00 per year, depending on experience, location, and employer.

What is a claims unit manager?

Claims Unit Managers are professionals who oversee a team of claims adjusters or examiners within an insurance company. They are responsible for managing daily operations, ensuring claims are processed accurately and efficiently, and maintaining compliance with company policies and legal regulations. Claims Unit Managers also handle escalated or complex cases, provide training and mentorship to staff, and monitor performance metrics to improve service quality. Their role is essential in ensuring fair and timely settlements for policyholders while minimizing risk for the company.

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

To thrive as a Claims Unit Manager, you need expertise in claims processing, insurance regulations, team leadership, and typically a bachelor's degree in business, finance, or a related field. Familiarity with claims management systems, data analysis tools, and, in some cases, certifications like AIC (Associate in Claims) are highly valued. Strong communication, problem-solving, and organizational skills help foster an effective team environment and ensure high service standards. These skills and qualities are crucial to efficiently managing claims operations, minimizing risk, and ensuring regulatory compliance.

What are some common challenges faced by claims unit managers, and how can they effectively address them?

Claims Unit Managers often encounter challenges such as balancing workloads across their teams, ensuring compliance with ever-changing regulations, and maintaining high levels of customer satisfaction. To address these, it's important to implement efficient workflow systems, provide ongoing training for staff on regulatory updates, and foster a collaborative team environment. Regular communication with both team members and upper management is also key to identifying bottlenecks early and implementing solutions proactively.

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

AspectClaims Unit ManagerClaims Adjuster
CredentialsRelevant certifications (e.g., CPCU, ARM), leadership experienceLicenses as required by state, insurance adjuster certifications
Work EnvironmentSupervisory role overseeing teams, administrative tasksField or office-based, evaluating claims and interviewing claimants
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, independent adjusting firms
Search & Comparison IntentManagement, leadership, team oversightClaims evaluation, settlement, investigation

The Claims Unit Manager typically oversees a team of claims adjusters, focusing on management, strategy, and administrative duties. In contrast, a Claims Adjuster directly investigates and settles claims. Both roles require insurance knowledge and certifications, but the managerial position emphasizes leadership and team coordination, while the adjuster role centers on claim assessment and resolution.

What job categories do people searching Claims Unit Manager jobs in Lexington, SC look for?

The top searched job categories for Claims Unit Manager jobs in Lexington, SC are:

What cities near Lexington, SC are hiring for Claims Unit Manager jobs?

Cities near Lexington, SC with the most Claims Unit Manager job openings:

Claims Unit Manager jobs near you

RN/Managed Care Coordinator - Remote

Columbia, SC • Remote

CEI
See more jobs at CEIexternal

Full-time

Re-posted 24 days ago

Job description

Must live in the state of South Carolina.
Must be able to work the first 4-6 weeks onsite in Columbia, then will go remote.
Must have an active, unrestricted RN License in the state of South Carolina.
Must have experience in one of the following -  Critical Care, ICU, ER, Cardiac PACU, Progressive Care Unit or Step-down units
M-F 8-5
Pay - 38/hr
Description - 
  • Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions.
  • Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness.
  • Utilizes available resources to promote quality, cost effective outcomes.
  • Provides active case management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals.
  • Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions.
  • Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions that consist of: intensive assessment/evaluation of condition, at risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement.
  • Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines.
  • Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.).
  • Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
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