Medical Claims Manager Jobs in Appleton, WI (NOW HIRING)

Who we are: 

ManhattanLife Insurance and Annuity Company was founded in 1850, the Company’s longevity makes it one of the oldest and most reliable health and life insurance companies in the country. Operating successfully for over 175 years is a testimony to ManhattanLife’s enduring history, and an indicator of the reliability of our future. ManhattanLife’s headquarters are in Houston, TX and the company is continually growing with multiple office locations nation-wide. ManhattanLife offers attractive employee benefits starting day one, including immediate coverage under our health, dental and vision plans. We offer flexible schedules, including shortened hours on Fridays, company-wide events, professional development, and a company-wide wellness program.

Scope and Purpose:

ManhattanLife is seeking an Insurance Claims Supervisor for our Voluntary Benefits Division. As a Claims Supervisor, you will oversee the daily operations of a team of claim examiners that process benefits payable under several of our group product types. This is a combination of health and life. Your objective will be to ensure this department reviews all claims accurately, promptly, and thoroughly while also determining the action steps that your team needs to take to provide an industry-leading customer experience for our claimants. 

 

Duties and Responsibilities:

• Organize and improve the documentation and procedures involved in training new employees. 
• Accurately determine complex claim benefits payable based on medical records, contract language and any additional information needed to reach the appropriate decision in a timely manner. This includes both payment and denial of benefits. 
• Ensure that all claims are assigned in a timely manner and to the appropriate claim examiner based on workload, claim volume, type of claim and the examiner’s level of experience. 
• Communicate with external and internal customers to obtain specific claim information to finalize claims and to explain claim handling. 
• Review and respond to escalated claim inquiries, claim appeals, and complaints in a timely manner. 
• Provide insights and recommendations for enhancements to claim processes, training procedures, system improvements and auditing. 
• Make appropriate referrals to other departments including but not limited to legal, underwriting, and policyholder services. 

 

Minimum Qualifications:

Bachelor’s degree or equivalent relevant work experience in the insurance or finance industries.

 

Knowledge, Skills and Abilities:

• At least 3 years of financial transaction and/or claims handling experience in progressively responsible roles, including supervisory functions. 
• Insurance designations preferred.
• Strong oral, written and interpersonal communication skills, sound judgment and the ability to think within a structured and compliant work environment while focusing on the customer. 
• Demonstrated understanding of computer systems such as email, data entry, and Microsoft products, with proficient keyboarding skills. 
• Ability to work flexible shifts and maintain regular and predictable attendance with adherence to department and company attendance expectations. May be required to work overtime based on business needs. 

 

Travel Requirements 

This position may require light travel. 

Professional Development:

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is regularly required to stand; walk; use hands to finger, handle or feel objects, type, and use mouse; reach with hands and arms and talk and/or hear. The employee is required to sit for extended periods of time. The position may require lifting, pulling or moving items weighing upwards of 10 pounds as it relates to office or desk supplies.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee regularly works in an office environment. This role routinely uses standard office equipment such as computers, phones via WebEx, physical phone while in office, and photocopiers when necessary.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to the job at any time without notice.

AAP/EEO Statement:

ManhattanLife prohibits discrimination based on race, religion, gender, national origin, age, disability, veteran status, marital status, pregnancy, gender expression or identity, sexual orientation, or any other legally protected status. EOE Employer/Vet/Disabled. ManhattanLife values differences. We are committed to fostering an environment that attracts and retains a diverse workforce. With individuals from a variety of backgrounds, ManhattanLife will be better equipped to service our customers, increase innovation, and reduce risks. We encourage the unique perspectives of individuals and are dedicated to creating a respectful and inclusive work environment.