Senior Medical Claims Manager

Role Overview

This position leads a claims operation within an insurance organisation, overseeing the full lifecycle of claims from initial notification through to settlement or denial. Day to day, the role involves managing a team of claims professionals, ensuring workflows run efficiently, and maintaining compliance with internal policies and regulatory standards. Your work directly impacts customer satisfaction and the financial integrity of the claims process, making accuracy and fairness essential to the organisation’s reputation.

Key Responsibilities

• Direct and supervise a claims team, allocating workloads, setting performance targets, and conducting regular reviews to ensure quality and productivity.
• Review complex or high-value claims, making final decisions on coverage, liability, and settlement amounts in line with policy terms and regulations.
• Develop and implement claims handling procedures to streamline operations, reduce cycle times, and minimise errors across the department.
• Monitor key performance indicators such as claim duration, cost per claim, and customer satisfaction, then adjust strategies to meet targets.
• Serve as the escalation point for disputes, negotiating resolutions with claimants, brokers, and legal representatives while protecting the company’s interests.
• Coach, mentor, and train junior claims staff, fostering a culture of accountability, technical competence, and continuous improvement.
• Liaise with underwriting, actuarial, and risk management teams to share claims insights that inform pricing and policy decisions.
• Prepare management reports on claims trends, reserves, and operational outcomes, presenting findings to senior leadership.

Requirements & Qualifications

• Bachelor’s degree in a relevant field such as business administration, healthcare management, finance, or similar; advanced certifications in claims management or insurance (e.g., AIC, ARM, CPCU) are preferred.
• At least eight years of experience in the insurance industry, with a substantial portion dedicated to claims management in a supervisory or leadership capacity.
• Strong leadership skills, including the ability to motivate teams, manage competing priorities, and drive performance in a fast-paced environment.
• Analytical and problem-solving capabilities, with a proven track record of assessing complex information and reaching sound, defensible decisions.
• Excellent communication and interpersonal skills, equally comfortable explaining technical matters to colleagues, customers, and external stakeholders.
• A customer-focused mindset, with a commitment to delivering fair, transparent service even when handling difficult or contentious claims.
• Meticulous attention to detail, capable of maintaining accuracy while managing a high volume of claims and documentation.
• Demonstrated decision-making and conflict resolution skills, able to remain composed under pressure and negotiate outcomes that balance customer needs and business sustainability.