Team Manager (US Healthcare Insurance)

The Associate Manager STD Claims will lead and manage a ShortTerm Disability (STD) claims team operating in a voice or blended (voice + nonvoice) environment. This role ensures accurate claim adjudication, highquality customer interactions, compliance with regulatory standards, and consistent delivery of service KPIs. The position requires strong people leadership, operational oversight, and the ability to manage both callbased and backoffice claim functions.

Key Responsibilities

• Team Leadership Lead, coach, and mentor STD Claims Analysts handling both voice and blended workflows; conduct performance reviews and support career development.
• Voice/Blended Operations Oversee inbound/outbound claimant calls, employer communication, and documentation accuracy while ensuring empathetic and compliant interactions.
• Claims Oversight — Monitor endtoend STD claim processing, ensuring timely adjudication aligned with policy terms, medical documentation, and regulatory requirements.
• Quality & Compliance — Ensure all voice and nonvoice interactions meet quality benchmarks, ERISA guidelines, HIPAA standards, and internal audit requirements.
• Performance Management — Track KPIs including AHT, call quality, SLA, TAT, productivity, and accuracy; implement action plans for improvement.
• Workflow & Queue Management — Manage staffing, schedule adherence, call queues, and claim inventory to prevent aging and backlog.
• Stakeholder Collaboration — Coordinate with medical review teams, HR partners, employers, legal, and client representatives to resolve escalations.
• Training & Coaching — Conduct training on call handling, claims adjudication, documentation standards, and customer empathy.
• Process Improvement — Identify gaps in voice/blended workflows and implement solutions to enhance efficiency and customer experience.
• Reporting & Insights — Prepare weekly/monthly dashboards, analyze trends, and present operational insights to leadership.
• Customer Experience — Ensure highquality claimant interactions, timely updates, and empathetic communication throughout the claims lifecycle.

Qualifications

Our most successful candidates will have:

• 5+ years of experience handling voice and blended process team for US Insurance or health insurance claims
• Claims Expertise — 3–5+ years of experience in STD, LTD, disability, or health insurance claims; strong understanding of claim adjudication.
• Voice Process Experience — Prior experience managing voice or blended operations in insurance, healthcare, or financial services.
• Regulatory Knowledge — Familiarity with ERISA, HIPAA, state disability laws, and insurance compliance standards.
• Leadership Skills — Proven ability to lead teams, manage performance, and drive operational excellence.
• Analytical Skills — Strong decisionmaking ability with experience reviewing medical records and policy language.
• Communication Skills — Excellent verbal and written communication for claimant calls, employer interactions, and stakeholder coordination.
• Process Orientation — Strong focus on accuracy, documentation, and compliance.
• Tools & Systems — Experience with claims management platforms, callhandling systems, and MS Office.