Claims Manager II

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you!

Modivcare is looking for an experienced Claims Manager II to join our team. This role is responsible for managing the operations of claims intake for the Legal Department, ensuring alignment with operational, financial, and service expectations. This includes overseeing the intake and processing of insurance claims related to personal, property, and casualty loss. The individual in this role will develop and implement best practices for claims resolution and investigation in accordance with company policies and procedures.

This role…

Insurance Claims Reporting Process

• Acts as the primary point of contact for all insurance claims.

• Reports all claims and litigation to appropriate insurers.

• Coordinates and collaborates with insurance adjusters and claim advocates.

Pre-litigation Claims

• Communicates with claimants and their attorneys as needed.

• Engages with claimant attorneys to gather additional information.

• Submits claims to third parties when appropriate.

• Conducts initial investigation and evaluation of claims.

• Obtains internal documentation and records related to claims (e.g., third-party agreements, certificates of insurance, clinical/employee records).

• Identifies and ensures legal holds are initiated timely.

• Develops processes to organize and track pre-litigation claims.

• Coordinates with internal counsel, insurance carriers, adjusters, attorneys, and other stakeholders to resolve claims efficiently and favorably.

• Collaborates with internal counsel on early resolution of claims and determining the need for early engagement of outside counsel.

Manage Claims Handling Process

• Contributes to the development of best practices for claims handling from incident through litigation.

• Develops and implements procedures to improve efficiency and effectiveness.

• Leads claim reviews and ensures they are conducted timely.

• Provides periodic analysis of adjuster responsiveness and effectiveness.

• Develops a Claims Reporting/Handling Manual or Toolkit.

Manage Significant Incident Process

• Oversees YORS Tier 1 Incidents.

• Participates in emergency calls to assess potential claims and recommend action.

• Evaluates significant incidents and reports to insurers when necessary.

• Consults with internal counsel regarding the engagement of outside defense counsel for severe matters.

• Improves incident response processes on the front end.

• Recognizes when legal holds are required and ensures timely reporting to carriers.

Litigation Management

• Collaborates with internal counsel, outside counsel, and insurance carriers on active litigation.

• Ensures timely payment of claims and litigation-related costs.

• Assists in the evaluation of Modivcare’s defense counsel panels.

• Provides support during mediations and other legal matters.

• May lead projects and perform other duties as assigned.

We are interested in speaking with individuals with the following…

• Bachelor’s Degree required.

• Ten (10) plus years of experience managing large claims and claims processes.

• Or equivalent combination of education and/or experience.

• Strong understanding of claims processing and ability to make informed decisions on claim eligibility.

• Excellent attention to detail and proficient data entry skills for accurate claim processing.

• Intermediate proficiency with Microsoft applications (Word, Excel, and Outlook).

• Analytical mindset with the ability to interpret claim data and follow established guidelines.

• Excellent verbal and written communication skills with a superior customer-focused demeanor.

• Problem-solving abilities to address claim issues and resolve discrepancies.

• Ability to work independently and as a member of a team.

Salary: $92,500 - $124,900

Bonus eligible based on individual and company performance.

Modivcare’s positions are posted and open for applications for a minimum of 5 days. Positions may be posted for a maximum of 45 days dependent on the type of role, the number of roles, and the number of applications received.  We encourage our prospective candidates to submit their application(s) expediently so as not to miss out on our opportunities. We frequently post new opportunities and encourage prospective candidates to check back often for new postings. 

We value our team members and realize the importance of benefits for you and your family.

Modivcare offers a comprehensive benefits package to include the following:

• Medical, Dental, and Vision insurance
• Employer Paid Basic Life Insurance and AD&D
• Voluntary Life Insurance (Employee/Spouse/Child)
• Health Care and Dependent Care Flexible Spending Accounts
• Pre-Tax and Post --Tax Commuter and Parking Benefits
• 401(k) Retirement Savings Plan with Company Match
• Paid Time Off
• Paid Parental Leave
• Short-Term and Long-Term Disability
• Tuition Reimbursement
• Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)

Modivcare is an Equal Opportunity Employer.

• EEO is The Law - click here for more information
• Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
• We consider all applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law. If you need assistance, please reach out to us at [email protected]