Sr Manager, Claims
New
USFull-TimeManager
Salary74,800 - 102,300 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- 7–10 years of experience in claims operations, including 3–5 years in a leadership or management role.
- Required Skills
- LeadershipData AnalysisRisk ManagementProcess improvement
Requirements
- Bachelor’s degree in Business, Healthcare Administration, Finance, or a related field (or equivalent experience).
- 7–10 years of experience in claims operations, including 3–5 years in a leadership or management role.
- Strong background in regulated industries such as healthcare or insurance, preferably with Medicare Advantage, Medicaid, or supplemental health plans.
- Proven experience developing and executing compliance programs aligned with CMS, HIPAA, or similar frameworks.
- Experience managing operational audits, regulatory reviews, or accreditation processes.
- Demonstrated ability to lead cross-functional teams and collaborate with executive stakeholders.
- Strong analytical, problem-solving, and data interpretation skills.
- Experience with claims systems, workflow tools, and automation initiatives.
- Excellent communication, presentation, and organizational skills with strong attention to detail.
Responsibilities
- Lead end-to-end claims operations, ensuring accuracy, timeliness, and compliance with service level agreements and internal standards.
- Manage and develop a team of claims professionals, supervisors, and analysts across multiple functional areas.
- Establish, track, and improve key performance indicators including cycle time, accuracy, denial rates, and cost per claim.
- Drive process improvement and automation initiatives to enhance efficiency and reduce manual workflows.
- Oversee risk management activities, including identification, mitigation planning, escalation protocols, and business continuity planning.
- Monitor fraud, waste, and abuse indicators and coordinate investigations with internal and external stakeholders.
- Ensure compliance with CMS, HIPAA, and state-level healthcare regulations, translating requirements into operational policies.
- Lead audit preparation and act as the primary point of contact during internal and external audits.
- Collaborate with IT, legal, finance, and vendors to align systems, workflows, and operational objectives.
- Present operational performance, risk insights, and compliance updates to senior and executive leadership.
View Full Description & ApplyYou'll be redirected to the employer's site
