Claims Finance Manager

Careington International is looking to add a Claims Finance Manager to our TEAM. This position will be worked onsite at 7400 Gaylord Pkwy in Frisco, TX.

The Claims Finance Manager serves as the critical link between Claims Operations and Corporate Finance, ensuring financial accountability, payment accuracy, and operational efficiency throughout the claims adjudication lifecycle. This role translates claims activity into financial insights by analyzing claim costs, reimbursement trends, adjudication outcomes, reserve impacts, and operational performance.

The Claims Finance Manager partners with Accounting & Finance, Claims, Configuration, Revenue Operations, Product, and Executive Leadership to evaluate the financial impact of claims decisions, identify opportunities to reduce payment leakage, improve adjudication accuracy, and support strategic business objectives. This position plays a key role in balancing financial stewardship, customer obligations, and operational excellence.

EXPECTED WORK AND PERFORMANCE: 

Claims Finance & Financial Oversight

• Serve as the primary liaison between Claims Operations and Accounting & Finance, bridging claims adjudication activities with corporate financial objectives


• Analyze claims payment activity, funding, payment activity, adjudication outcomes, and reimbursement trends to ensure financial accuracy and integrity


• Monitor claim costs, payment variances, financial leakage, recoveries, and adjustments


• Evaluate the financial impact of claim processing decisions, benefit configurations, and reimbursement methodologies


• Support the development of financial controls that ensure accurate and compliant claim payments


• Manage the claims operational financial tasks such as:
  
  
  
  • Client Request for Funds/Credits
  
  
  • Provider Claim Payment Cycle Processing
  
  
  • Provider Recoupments
  
  
  • Own the reconciliation of claims funding, payment disbursements, credits, recoupments, refunds, and related general ledger activity
  
  
  • Research and resolve variances, aged reconciling items, unapplied funds, outstanding payments, and funding shortfalls in partnership with Claims and Accounting & Finance
  
  
  
  

Claims Adjudication Analysis

• Review adjudicated claims to identify trends, anomalies, and opportunities for process improvement


• Partner with Claims and Configuration teams to investigate payment discrepancies and adjudication errors


• Analyze denial, appeal, adjustment, and rework trends to identify operational and financial risks


• Monitor first-pass adjudication rates, auto-adjudication performance, and payment accuracy metrics


• Provide recommendations to improve claims accuracy while reducing administrative costs

Financial Planning & Reporting

• Develop financial reports, dashboards, and analyses related to claims operations


• Support budgeting, forecasting, and financial planning activities related to claims volume, costs, and operational expenses


• Prepare executive-level reporting on claims financial performance, trends, risks, and opportunities


• Translate operational claims data into meaningful financial insights for leadership decision-making

Business Partnership & Strategy

• Collaborate with Claims Leadership, Product, Technology, Client Services, and Finance teams to support organizational goals


• Assess the financial impact of system enhancements, configuration changes, new client implementations, and process improvements


• Support strategic initiatives focused on reducing claim costs, improving adjudication efficiency, and increasing profitability


• Provide financial guidance during audits, client reviews, and operational assessments

Risk Management & Compliance

• Ensure claims-related financial processes comply with contractual, regulatory, and organizational requirements


• Support internal and external audits related to claims payments and financial controls


• Identify financial risks associated with claims processing and recommend mitigation strategies


• Maintain oversight of payment integrity and recovery initiatives

People Management & Development

• Effectively manage, coach and development members of the team.

QUALIFICATIONS:

Required

• Bachelor's degree in Finance, Accounting, Business Administration, Healthcare Administration, or related field


• 5+ years of experience in finance, claims operations, healthcare administration, insurance, or revenue cycle management


• Strong understanding of claims adjudication, reimbursement methodologies, and payment integrity principles


• Experience performing financial analysis and reporting in a claims-driven environment


• Advanced Excel and data analysis skills

Preferred

• Experience within healthcare claims administration, dental benefits, vision benefits, TPAs, or insurance organizations.


• Working knowledge of financial procedures like escheatment and 1099 processing.


• MBA, CPA, CMA, or similar professional certification.


• Experience with claims adjudication platforms, payment integrity tools, and business intelligence reporting systems.

 SKILLS: 

• Strong understanding of both claims operations and financial management principles.


• Ability to connect operational claim outcomes with financial performance.


• Expertise in claims payment analysis, reimbursement methodologies, and cost containment strategies.


• Strong analytical and problem-solving skills.


• Ability to communicate complex financial concepts to operational leaders.


• Experience leading cross-functional initiatives and process improvement efforts.


• Excellent presentation, reporting, and stakeholder management skills.