Highmark Health Claims Manager Reporting in Pittsburgh, Pennsylvania



This job manages and develops all direct and indirect reports with responsibility for handling all claims processing and adjustment workloads for multiple customer segments. Maintaining the Professional Consultant network, performing the Medical review, translating foreign claims and processing claims with unique processing arrangement. Fully utilizes the support mechanisms available to complete the required delivery of high performance, low cost production. Supports strategic planning under the direction of the Director. Be able to select, develop and continuously coach staff to the highest levels of performance. Motivates and team builds through the creation of a work environment and conditions that contribute to highest levels of performance.


  • Communicate effectively

  • Provide functional area staff coaching.

  • Manage preparation and implementation of area objectives and ensure these are met in accordance with strategies.

  • Ensure workload standards are met through efficient utilization of staff in collaboration and support of the command center, regular audits of relevant systems as well as up to date statistics and reports.

  • Evaluate trends, customer feedback and business initiatives and changes to ensure appropriate planning, training and allocation of resources to successfully achieve desired performance objectives.

  • Analyze issues specific to functional area and create business cases to support recommendations on further development of the current processes, procedures and staffing.

  • Daily monitor, observe, and evaluate various work processes and individual skills applied in the work place to achieve optimum performance and model behavior.

  • Other duties as assigned or requested.



  • High School Diploma or GED

  • 5 years management experience

  • 5 years experience in large operations environment

  • 3 years experience with insurance products principles, industry practices and processes


  • Bachelors degree


  • Have an in-depth understanding of the system in which that work is performed – the process, tools and the people – and be able to cost effectively produce the highest levels of high quality output and throughput. This includes knowing how the inputs and outputs of the process area they manage impacts upstream and downstream processes


Does this role supervise/manage other employees?



Is Travel Required?


Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies


Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled