Opportunity at
SutherlandTeam Manager | AO Clinical Claims (Pooling)
Sutherland is hiring a Team Manager for its Accident & Occupational Clinical Claims operations. This position entails directing a group of USRN Clinical Claims Specialists and…
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About This Role
Sutherland is hiring a Team Manager for its Accident & Occupational Clinical Claims operations. This position entails directing a group of USRN Clinical Claims Specialists and Associates to meet business goals. The ideal candidate will provide daily operational direction, clinical advice, performance management, and coaching. Responsibilities include ensuring adherence to productivity metrics, turnaround times, quality standards, regulatory compliance, and employee engagement targets. The role requires partnering with HR on employee…
Job Description
Sutherland is hiring a Team Manager for its Accident & Occupational Clinical Claims operations. This position entails directing a group of USRN Clinical Claims Specialists and Associates to meet business goals. The ideal candidate will provide daily operational direction, clinical advice, performance management, and coaching. Responsibilities include ensuring adherence to productivity metrics, turnaround times, quality standards, regulatory compliance, and employee engagement targets. The role requires partnering with HR on employee relations, analyzing performance data, and implementing corrective action plans. Additionally, the manager will assist operations leadership during client discussions, support process improvement projects, and maintain compliance with data privacy and HIPAA standards. This opportunity suits professionals with a background in healthcare operations and nursing leadership.
Responsibilities
- Manage daily workflows for assigned clinical claims teams
- Monitor team metrics including quality, accuracy, compliance, productivity, and turnaround times
- Analyze performance data and execute action plans to close performance gaps
- Coach, lead, and develop Clinical Claims Associates and Specialists
- Conduct career discussions, regular performance reviews, and attendance management
- Partner with HR and operations leadership to handle employee relations
- Ensure strict adherence to data privacy, HIPAA, and regulatory standards through audits
- Join client discussions and business reviews alongside operations leadership
- Lead change management initiatives and workflows optimization projects
Requirements
- Active and unrestricted US Registered Nurse license
- Bachelor of Science in Nursing or equivalent nursing degree
- At least three to five years of clinical nursing background in settings such as hospitals, healthcare, disability claims, utilization review, insurance, or case management
- Minimum of two years of people leadership experience managing healthcare accounts, clinical teams, BPO healthcare operations, or claims processing
- Familiarity with healthcare processes, clinical documentation, and medical terminology
- Proficiency in written and verbal English communication
- Internal candidates must hold an annual PDP score of Outstanding (5) or Exceeds Expectations (4)
- Internal candidates need a minimum tenure of 18 months in their current role and no active disciplinary action
Qualifications
- Background in disability claims management, clinical claims review, utilization management, case management, health insurance operations, or healthcare BPO
- Prior experience overseeing US healthcare or insurance accounts
- Process improvement, quality, or Lean Six Sigma certification
- Familiarity with healthcare compliance and HIPAA rules
- Experience conducting client-facing operational presentations and reviews
Core Skills
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
What is the primary function of the Team Manager?
The Team Manager leads a group of USRN Clinical Claims Specialists and Associates, driving operational excellence, quality standards, productivity targets, compliance, and employee engagement.
What experience is required for this role?
Candidates must have an active and unrestricted USRN license, a BSN or equivalent, three to five years of clinical nursing experience, and at least two years of people management experience in healthcare or claims operations.
Is the work location or remote policy specified?
No, the posting does not specify the work location or whether the role is remote or on-site.
Are salary details provided in the posting?
No, salary information is not stated in the job description.
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