Manager, Claims Operations
93000 - 126000 USD per year
Company:
Location:US-based remote locations
Languages:English
Seniority level:Manager, 4+ years
Experience:4+ years
Skills:
LeadershipProject ManagementSQLData AnalysisPeople ManagementQAJiraProduct OperationsCross-functional Team LeadershipOperations ManagementBusiness OperationsDocumentationCommunication SkillsAnalytical SkillsProblem SolvingMentoringAttention to detailOrganizational skillsWritten communicationComplianceTeam managementStakeholder managementTrainingTroubleshootingProcess improvementAnalytical thinking
Requirements:
4+ years of experience in health insurance claims processing Strong familiarity across institutional and professional claims, coding standards (ICD, CPT/HCPCS, revenue codes), and regulatory requirements 2+ years managing and developing teams Exceptionally organized with strong time-management skills Process-builder with a startup mindset Gritty problem-solver Excellent verbal and written communication skills Analytical and data-driven, with experience in spreadsheets and (ideally) SQL
Responsibilities:
Manage and develop a team of Claims and Appeals Processors Own end-to-end claims operations, including adjudication, appeals, QA, IDR negotiations, and compliance Develop and strengthen scalable processes by documenting SOPs and identifying workflow improvements Manage customer support and provider escalations Oversee rule-based payment logic, collaborating with Product and Engineering Build and maintain plan document infrastructure Serve as claims subject-matter expert for internal teams and manage vendor relationships Develop KPIs and reporting dashboards to monitor performance Partner on payment integrity and cost containment programs Drive cross-functional projects
