051802-Claims Manager – Healthcare

About Capgemini


Capgemini is a global leader in consulting, digital transformation, technology and engineering  services. The Group is at the forefront of innovation to address the entire breadth of clients’ opportunities in the evolving world of cloud, digital and platforms. Building on its strong 50-year+ heritage and deep industry-specific expertise, Capgemini enables organizations to realize their business ambitions through an array of services from strategy to operations. Capgemini is driven by the conviction that the business value of technology comes from and through people. Today, it is a multicultural company of 270,000 team members in almost 50 countries. With Altran, the Group reported 2019 combined revenues of €17billion.


Visit us at www.capgemini.com. People matter, results count



Capgemini is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, national origin, gender identity/expression, age, religion, disability, sexual orientation, genetics, veteran status, marital status or any other characteristic protected by law.

This is a general description of the Duties, Responsibilities and Qualifications required for this position. Physical, mental, sensory or environmental demands may be referenced in an attempt to communicate the manner in which this position traditionally is performed. Whenever necessary to provide individuals with disabilities an equal employment opportunity, Capgemini will consider reasonable accommodations that might involve varying job requirements and/or changing the way this job is performed, provided that such accommodations do not pose an undue hardship.


 Click the following link for more information on your rights as an Applicant –http://www.capgemini.com/resources/equal-employment-opportunity-is-the-law







Role Overview:
This job is responsible for overseeing Claims Department, providing an independent assessment of disputed claims, handle client and end customer escalations, providing quality and efficient responses to appeals and department of Insurance complaints. Additional responsibilities include assisting Engagement Director with process improvements, development, analysis and implementation of Industry practices, ensuring Claims department is adhering to all laws and regulations.


•Directs and oversees the operations of Insurance claims department to meet operation, financial, and service requirements. 
•Provides guidance on Insurance claims that require supervisor reviews, response to Complaints raised by Client and customers. Provides guidance to subordinates on the most complex claims.
•Responsible for the strategic processing and payment of claims. 
•Keeps abreast of any changes to legislation and regulations which pertain to insurance claims. 
•Manages a departmental sub-function including Intake, Eligibility, Payments and Appeals within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. 
•Ensure claims are adjudicated as per the guidelines of the company. Provide continual evaluation of processes and procedures.  Responsible for suggesting methods to improve area operations, efficiency and service to both internal and external customers. 
•Ensures the SLAs are reviewed and revised annually or as required. SLA analytics on baselining and benchmarking.
•Provide statistical and performance feedback and coaching on a regular basis to each team member.  Write and administer performance reviews for skill improvement.
•Ensure employees have appropriate training and other resources to perform their job.  
•Responsible to provide direction, allocate knowledgeable resources for UAT, change management, and DR testing. 
•Responsible for guidance on functional needs for IT applications and systems enhancements.
•Responsible for reviews of BCP and DR plans as defined by contracts and organization standards
•Respond to and resolve customer issues.  
•Establish work procedures and processes that support company and departmental standards, procedures and strategic directives.
•Communicate with upper management regarding department or employee concerns.
•Complying with company regulations regarding HIPAA, confidentiality, and private health information.


To perform these jobs successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•Excellent oral, written and interpersonal communication skills
•Knowledge of Microsoft Office applications and telephone protocol
•Exceptional listening and analytical skills
•Strong knowledge of Claims Department
•Demonstrated ability to work well in a team environment
•Proven leadership experience
•Ability to provide and support company goals.


•Minimum of bachelor’s degree. Masters will be added plus
•5+ years of Managerial Experience
•Excellent communication skills both verbal and written are required.
•Deep knowledge of the managed sub-function and solid knowledge of the overall Claims departmental function
•Long Term Industry experience preferred


•Can understand a wide range of demanding, longer texts, and recognize implicit meaning.
•Can express him/herself fluently and spontaneously without much obvious searching for expressions.
•Can use language flexibly and effectively for social, academic and professional purposes.
•Can produce clear, well-structured, detailed text on complex subjects, showing controlled use of organizational patterns, connectors and cohesive devices

Candidates should be flexible / willing to work across this delivery landscape which includes and not limited to Agile Applications Development, Support and Deployment.



Posted on:

February 8, 2021

Experience level:


Education level:

Bachelor's Degree (±16 years)

Contract type: