Job Title: Medical Claims Account Manager

Reports To: CFO
FLSA Status: Exempt
Job Type: Permanent / Full-Time
Schedule: Monday – Friday, 9:30 AM – 6:00 PM
Location: Glastonbury, CT 06033

Summary

The Medical Claims Account Manager is responsible for delivering high-quality client service and overseeing contractual obligations with key clients, including state agencies and other designated organizations. This role involves managing administrative processes related to health premiums and medical out-of-pocket expenses, handling client inquiries, resolving complaints, and ensuring compliance with service level agreements (SLAs).

Essential Duties and Responsibilities

The following duties are representative of the role. Other duties may be assigned as needed.

• Maintain comprehensive knowledge of client programs, goals, and system capabilities, especially relating to data reporting and operational functionality.

  
  

• Coordinate and compile reports and formal responses for clients.

  
  

• Establish and maintain strong, professional client relationships through proactive communication and trust-building.

  
  

• Serve as the primary point of contact for assigned clients during normal business hours.

  
  

• Facilitate program meetings and conference calls, leading discussions and ensuring follow-up actions are completed.

  
  

• Collaborate with internal departments such as customer service and insurance benefits management to provide guidance and resolve issues.

  
  

• Conduct quality assurance reviews to confirm SLA adherence and reporting accuracy.

  
  

• Monitor contract compliance by reviewing deliverables, tracking key deadlines, and alerting senior leadership of renewal or expiration dates.

  
  

• Interpret Explanation of Benefits (EOBs) and use healthcare terminology to process claims accurately.

  
  

• Process and adjust medical claims and appeals according to established policies and procedures.

  
  

• Prepare and update financial batch records for submission to the finance department.

  
  

• Supervise daily team workflow, promote collaboration, and ensure service delivery targets are met.

  
  

• Identify, research, and resolve claim issues, including requesting additional documentation when necessary.

  
  

• Recommend and implement process improvements for operational efficiency.

Medical Claims Requirements

• Medical Coding and Billing Certification or equivalent relevant experience

  
  

• Strong understanding of medical claims processing and healthcare industry practices

  
  

• Prior experience in a supervisory or managerial capacity

  
  

• Familiarity with medical claims clearinghouses

Qualifications

To perform this role successfully, candidates must meet the following qualifications. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience:

• Bachelor’s degree (B.A./B.S.) in Account Management, Healthcare Administration, or related field; or

  
  

• Minimum of five years of account management experience in a healthcare or medical claims environment; or

  
  

• Equivalent combination of education and experience

Skills and Abilities

• Project management and organizational skills

  
  

• Strong verbal and written communication

  
  

• Ability to work efficiently and independently

  
  

• High attention to detail and accuracy

  
  

• Proven leadership and team coordination skills

  
  

• Proficiency in analyzing and resolving issues

  
  

• Ability to prioritize tasks and escalate concerns appropriately

  
  

• Experience with health insurance claims, premiums, and regulatory compliance

  
  

• Financial aptitude and data reporting skills

  
  

• Client service orientation and ability to deliver tailored solutions

  
  

• Bilingual capabilities are a plus

Technical Skills

• Proficient in Microsoft Office Suite (Excel, Word, Outlook)

  
  

• Experience with timekeeping, internet, and database software

  
  

• Familiarity with proprietary claims or financial software is a plus

Language and Reasoning Ability

• Read and interpret complex documents and procedural manuals

  
  

• Prepare written correspondence and present to groups professionally

  
  

• Apply mathematical concepts like fractions, ratios, percentages

  
  

• Analyze technical information and draw logical conclusions

Physical Demands

• Regularly required to sit, use hands, talk, and hear

  
  

• Occasionally required to stand, walk, and lift up to 25 pounds

  
  

• Vision abilities include close and distance vision

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