Claims Operations, Senior Manager
New
M
Meritain TPAHealthcare / Insurance
Based in United StatesFull-TimeManager
SalaryBase salary range of $75,400 to $182,549
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Job Details
- Experience
- Minimum 7 years of professional experience in claims operations
- Required Skills
- Business IntelligenceOperations ManagementQuality AssuranceProcess improvement
Requirements
- Minimum 7 years of professional experience in claims operations, with substantial experience in healthcare.
- Strong leadership experience managing large teams, with a focus on talent development and coaching.
- Strong execution and delivery skills, including planning and operational support capabilities.
- Proficiency in using business intelligence, data, and performance metrics to inform decisions.
- Advanced problem-solving and decision-making abilities for addressing complex operational challenges.
- Experience in third-party administration (TPA) and self-funded plans (highly preferred).
- Dental claims experience (preferred).
- Bachelor's degree, specialized training, or relevant professional qualification (preferred).
Responsibilities
- Lead and oversee a claims operations team responsible for the timely and accurate adjudication of self-funded, short-term medical, and/or dental claims.
- Develop and implement operational strategies to improve service delivery, efficiency, and stakeholder satisfaction.
- Manage team resources, budgets, and operational priorities to optimize performance and productivity.
- Monitor service quality, compliance, and performance metrics, implementing quality assurance programs as needed.
- Identify and implement process improvements to enhance operational effectiveness and streamline workflows.
- Research industry trends and technologies to identify opportunities for innovation and growth.
- Leverage healthcare technology and business intelligence to improve decision-making and service outcomes.
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