Claims Case Manager

The Claims Case Manager at Delta Group plays a critical role in supporting insurance carriers, third-party administrators (TPAs), self-insured entities, and other clients in managing and resolving insurance claims efficiently, accurately, and in compliance with client and regulatory requirements. This position combines strong claims handling expertise with sound judgment to move a portfolio of claims from intake through resolution, while recognizing fraud indicators and referring suspicious or questionable claims to the Special Investigations Unit when warranted.

Responsibilities

Claims Management

• Manage a portfolio of claims from intake through resolution, ensuring timely, accurate, and compliant handling.
• Review claim information for coverage considerations, completeness, documentation needs, and investigative requirements.
• Develop and manage claim strategies that support efficient resolution while meeting client objectives and service expectations.
• Prioritize workload and monitor case progression to ensure deadlines, service levels, and client commitments are met.

Investigation Coordination

• Identify potential fraud indicators, claim concerns, or investigative opportunities and coordinate referrals to the Special Investigation Unit (SIU) when appropriate.
• Coordinate investigative assignments with field investigators, adjusters, vendors, and internal resources.
• Review investigative findings, reports, and supporting documentation to ensure accuracy, completeness, and alignment with client requirements.
• Monitor investigative progress and facilitate timely resolution of outstanding issues.

Client & Stakeholder Management

• Serve as the primary point of contact for clients regarding claim status, investigative activities, timelines, budgets, and recommendations.
• Provide timely case updates and manage client expectations throughout the claim lifecycle.
• Collaborate with claims professionals, SIU personnel, investigators, vendors, and internal departments to support successful claim resolution.

Documentation & Operational Excellence

• Prepare claim summaries, final reports, and other client deliverables.
• Maintain accurate case documentation, financial records, activity notes, deadlines, and billing information within case management systems.
• Monitor case budgets and support compliance with client financial requirements.
• Identify opportunities to improve workflows, service delivery, operational efficiency, and client satisfaction.
• Maintain compliance with company policies, client requirements, confidentiality standards, and applicable regulations.
• Perform other duties as assigned.

Required Qualifications

Education

• Bachelor’s degree in criminal justice, or a related field, or an equivalent combination of education and relevant experience.

Experience

• Minimum of two years of insurance claims handling, claims management, or related experience.
• Experience managing claims from intake through resolution.

Skills & Knowledge

• Strong understanding of insurance claims processes, coverage concepts, claim lifecycles, and fraud indicators.
• Ability to evaluate claim information, investigative findings, and supporting documentation to make sound recommendations.
• Excellent written and verbal communication skills, including preparation of professional reports and client correspondence.
• Strong organizational, analytical, and case management skills with the ability to manage multiple claims simultaneously.
• Proficiency with Microsoft Office Suite, claims platforms, and case management systems.
• Knowledge of applicable insurance regulations and compliance standards.
• Ability to maintain confidentiality and appropriately handle sensitive and personally identifiable information (PII).

Preferred Qualifications

• Associate in Claims (AIC), Accredited Claims Adjuster (ACA), or comparable professional designation.
• Active adjuster license in one or more states.
• Experience handling multiple lines of insurance or multi-jurisdictional claims.
• Familiarity with medical billing, healthcare terminology, auto repair, construction, or other specialized claim disciplines.
• Experience with claims management technology, reporting platforms, or claims analytics tools.
• Knowledge of SIU referral processes and insurance fraud indicators.
• SIU or fraud-related certifications (e.g., CIFI, FCLS) preferred.
• Bilingual (Spanish preferred).

Physical Requirements

• Prolonged periods of sitting while working at a desk or workstation.
• Frequent use of hands and fingers for typing, data entry, and operating computer systems.
• Ability to read and interpret information displayed on computer monitors for extended periods.
• Ability to communicate effectively through phone, email, video conferencing, and other virtual communication platforms.
• Ability to maintain concentration and attention to detail while managing multiple assignments in a deadline-driven environment.
• Ability to occasionally lift or move office materials or equipment as needed.

Work Schedule

• Fully remote position requiring a professional, secure, and distraction-free home office environment.
• Standard schedule is Monday through Friday, 9:00 AM to 6:00 PM EST.
• Exempt position not eligible for overtime.
• Flexibility in work hours is expected based on workload, claim priorities, and client needs.
• Occasional extended hours may be required to meet business demands or critical deadlines.

Compensation Benefits

• Pay range: $55,000 - $65,000 annually. Actual compensation within the range is based on experience, qualifications, geographic location, and business needs.
• Bonus eligibility: This position may be eligible for a discretionary bonus based on individual performance, team contributions, and overall company results. Bonus eligibility, timing, and amounts are determined at the sole discretion of the company and are not guaranteed.
• Benefits summary: Delta Group offers a comprehensive benefits package designed to support the health, financial well-being, and work-life balance of employees, including:
  • Medical, dental, and vision insurance
  • Short-term disability (STD) and long-term disability (LTD) coverage
  • Whole life and term life insurance options
  • Accident and hospital indemnity insurance
  • 401(k) retirement plan with eligibility beginning after 90 days of employment
  • Generous paid time off (PTO) based on tenure
  • 7 paid holidays
  • Sick Leave and Bereavement Leave
  • Paid Parental Leave
  • Professional development and training opportunities

About the Company

Delta Group is a privately held, national investigative firm established in 1983 and headquartered in Buford, Georgia. As pioneers of unmanned surveillance technology, Delta Group’s eRemote® technology is an industry recognized product that continues to evolve and produce game-changing results. With more than 500 direct employees nationwide, our domestic footprint is large enough to matter and small enough to care.

We pride ourselves on developing and retaining professional staff while maintaining diversity within our team. Our executive leadership team brings over 100 years of combined experience leading national carrier fraud divisions, state fraud prosecutorial offices, claims and program management divisions, and investigative operations.
 

For over 41 years, our investigative resources have helped organizations reduce risk, improve profitability, and increase revenue within the insurance industry. Our expert employees are located throughout the United States, executing investigations for all types of claims including but not limited to, workers’ compensation, liability, auto, property, disability, and corporate investigations, regardless of size. Come join our talented team and our commitment to people, innovation and results.

Delta Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex (including pregnancy, sexual orientation, gender identity / expression), national origin or ancestry, genetic information (including family medical history), physical or mental disability, protected veteran status, or any other characteristic protected under federal, state or local law, where applicable, and those with criminal histories will be considered in a manner consistent with applicable state and local laws.

Compensation: $55k - $65k DOE