Alight Solutions
Senior Claim Operations Manager
Join Alight Solutions and lead a team of claims professionals representing a premier Fortune 100 client.
About The Role Responsibilities include coaching, guiding and leading a team of leave and disability managers with varying degrees of claim handling skills. This role will leverage expertise to navigate complex claim handling and payroll workflows and will oversee work across both Alight’s and the client’s payroll systems.
Responsibilities
Managing a dedicated team of leave and disability case managers covering a broad scope of leave of absence services including FMLA, company leaves, state leaves, Short Term Disability and Medical (ADAA) Accommodations.
Collaborating as a positive, enthusiastic, and results‑oriented team player with clinical leaders and senior leadership to deliver an exceptional “white glove” service.
Managing staff to ensure Performance Guarantees are met and reviewing documentation for approvals and denials and responding to periodic audits.
Leading a remote and hybrid team, defining roles and responsibilities, and establishing direct accountability to achieve business goals.
Complying with applicable laws and regulations, and documented procedures that incorporate preventive and defective controls.
Providing ongoing client support with the use of analytical skills to identify root cause of client claim handling issues and developing solutions and recommending appropriate actions.
Identifying opportunities for continuous improvement in claim handling, managing processes for leave specialists, disability case managers, and clinical case managers in collaboration with the account Program Director.
Managing and overseeing workload, performance management, staff schedules, personnel management, established Key Performance Indicators (KPI’s) and goal setting for the team.
Participating appropriately in client meetings and internal claim process improvement meetings and acting as a liaison between all parties and client stakeholders.
Being available for occasional escalations outside of normal business hours via an on‑call rotation schedule with MLOA leadership.
Requirements
Have advanced education and/or designation in healthcare, rehabilitation, or medical field. Work experience of ten + years, training and/or certification in case management, and a minimum of 3 years of claims leadership experience.
Show the proven ability to manage both day to day execution and projects to achieve results of business goals and special assignments.
Display excellent interpersonal communications skills both written and verbal. Be dedicated to providing high quality customer service, using diplomacy, patient advocacy, and professional competency.
Have advanced problem‑solving, analytical skills, communication, and client and staff relationship building skills.
Have management or supervisory experience and the ability to prioritize and assign work.
Display advanced level computer skills using Windows 2000 and Microsoft Office suite of programs including Word, Excel, PowerPoint and Outlook.
Hold a Lean Six Sigma Certification and/or formal Operations Strategy training.
Be adaptable, flexible, and able to lead/manage the team through change.
Demonstrate emotional intelligence, adaptability for complex challenges, critical thinking, and advanced business expertise.
Have experience as an exceptional leader of people who can mentor and build capabilities within a dedicated client team. Demonstrated talent management recruiting and retention strategies.
Demonstrate a solid understanding of leveraging technology, tools and data to drive innovation, operational improvements and customer experience.
Flexible Working We consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and “Top 100 Company for Remote Jobs” 5 years in a row.
Benefits We offer programs and plans for a healthy mind, body, wallet and life because it’s important our benefits care for the whole person. Options include a variety of health coverage options, wellbeing and support programs, retirement, vacation and sick leave, maternity, paternity & adoption leave, continuing education and training as well as several voluntary benefit options.
Equal Opportunity Policy Statement Alight is an Equal Employment Opportunity employer and does not discriminate against anyone based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state, or local law. In addition, we take affirmative action to employ disabled persons, disabled veterans and other covered veterans.
Legal and Compliance Statements Applicants for employment must have work authorization that does not require sponsorship of a visa for employment authorization in the Employing Country with Alight. Alight provides reasonable accommodations to the known limitations of otherwise qualified employees and applicants for employment with disabilities and sincerely held religious beliefs, practices and observances, unless doing so would result in undue hardship.
Salary Pay Range Minimum: 139,500.00 USD Maximum: 170,500.00 USD
Pay Transparency Statement: Alight considers a variety of factors in determining whether to extend an offer of employment and in setting the appropriate compensation level, including, but not limited to, a candidate’s experience, education, certification/credentials, market data, internal equity, and geography. Alight makes these decisions on an individualized, non‑discriminatory basis.
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About The Role Responsibilities include coaching, guiding and leading a team of leave and disability managers with varying degrees of claim handling skills. This role will leverage expertise to navigate complex claim handling and payroll workflows and will oversee work across both Alight’s and the client’s payroll systems.
Responsibilities
Managing a dedicated team of leave and disability case managers covering a broad scope of leave of absence services including FMLA, company leaves, state leaves, Short Term Disability and Medical (ADAA) Accommodations.
Collaborating as a positive, enthusiastic, and results‑oriented team player with clinical leaders and senior leadership to deliver an exceptional “white glove” service.
Managing staff to ensure Performance Guarantees are met and reviewing documentation for approvals and denials and responding to periodic audits.
Leading a remote and hybrid team, defining roles and responsibilities, and establishing direct accountability to achieve business goals.
Complying with applicable laws and regulations, and documented procedures that incorporate preventive and defective controls.
Providing ongoing client support with the use of analytical skills to identify root cause of client claim handling issues and developing solutions and recommending appropriate actions.
Identifying opportunities for continuous improvement in claim handling, managing processes for leave specialists, disability case managers, and clinical case managers in collaboration with the account Program Director.
Managing and overseeing workload, performance management, staff schedules, personnel management, established Key Performance Indicators (KPI’s) and goal setting for the team.
Participating appropriately in client meetings and internal claim process improvement meetings and acting as a liaison between all parties and client stakeholders.
Being available for occasional escalations outside of normal business hours via an on‑call rotation schedule with MLOA leadership.
Requirements
Have advanced education and/or designation in healthcare, rehabilitation, or medical field. Work experience of ten + years, training and/or certification in case management, and a minimum of 3 years of claims leadership experience.
Show the proven ability to manage both day to day execution and projects to achieve results of business goals and special assignments.
Display excellent interpersonal communications skills both written and verbal. Be dedicated to providing high quality customer service, using diplomacy, patient advocacy, and professional competency.
Have advanced problem‑solving, analytical skills, communication, and client and staff relationship building skills.
Have management or supervisory experience and the ability to prioritize and assign work.
Display advanced level computer skills using Windows 2000 and Microsoft Office suite of programs including Word, Excel, PowerPoint and Outlook.
Hold a Lean Six Sigma Certification and/or formal Operations Strategy training.
Be adaptable, flexible, and able to lead/manage the team through change.
Demonstrate emotional intelligence, adaptability for complex challenges, critical thinking, and advanced business expertise.
Have experience as an exceptional leader of people who can mentor and build capabilities within a dedicated client team. Demonstrated talent management recruiting and retention strategies.
Demonstrate a solid understanding of leveraging technology, tools and data to drive innovation, operational improvements and customer experience.
Flexible Working We consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and “Top 100 Company for Remote Jobs” 5 years in a row.
Benefits We offer programs and plans for a healthy mind, body, wallet and life because it’s important our benefits care for the whole person. Options include a variety of health coverage options, wellbeing and support programs, retirement, vacation and sick leave, maternity, paternity & adoption leave, continuing education and training as well as several voluntary benefit options.
Equal Opportunity Policy Statement Alight is an Equal Employment Opportunity employer and does not discriminate against anyone based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state, or local law. In addition, we take affirmative action to employ disabled persons, disabled veterans and other covered veterans.
Legal and Compliance Statements Applicants for employment must have work authorization that does not require sponsorship of a visa for employment authorization in the Employing Country with Alight. Alight provides reasonable accommodations to the known limitations of otherwise qualified employees and applicants for employment with disabilities and sincerely held religious beliefs, practices and observances, unless doing so would result in undue hardship.
Salary Pay Range Minimum: 139,500.00 USD Maximum: 170,500.00 USD
Pay Transparency Statement: Alight considers a variety of factors in determining whether to extend an offer of employment and in setting the appropriate compensation level, including, but not limited to, a candidate’s experience, education, certification/credentials, market data, internal equity, and geography. Alight makes these decisions on an individualized, non‑discriminatory basis.
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