A claims manager works in the insurance industry to coordinate and expedite the processing of customers' claims. The claims manager usually holds a management position with oversight for claims processes, helping ensure that any instances of misappropriation or fraud do not occur.
Many insurance claims are processed in the private sector by independent insurance agents, who submit payment proceedings to the company. In the field of health insurance, these claims are submitted by medical professionals seeking payment for procedures as well. It is the job of the claims manager to examine all notifications and claims received according to standards and practices within the industry and their organization to determine that they meet standards of worthiness. If they do, the manager then approves them and moves the claims along for processing and payment as expeditiously as possible.
In the medical field, the claims manager must also help with determinations of proper procedures and reasonable diagnostics being performed; insurance claims must conform to proper standards regarding diagnosis, equipment used, and the procedures performed.
The claims manager also provides updates and reports to the insuring institution that outline the movement of individual claims through the system. As such, claims managers must be organized and have a strong skill set in written and verbal communication. Aptitude with computers, databases, records, and spreadsheets is also valuable.
To work in this occupation, a claims manager typically has a bachelor's degree as well as some experience - usually three to five years - as claims adjusters or actuaries within an insurance organization. The work is normally performed in an office setting during regular business hours.
Claims Manager Tasks
- Investigates out of guidelines inquiries, and ensures compliance to procedures, proper services and settlement of claims.
- Report metrics, and assists senior management in developing and establishing policies and procedures.
- Manages the claims activity for a business unit.
- Oversees investigations and consultations with legal counsel.