Senior Healthcare Claims Operations Lead
New
J
J29Healthcare Consulting
Remote, Eastern Standard Time (EST) based in the Continental United States., Eastern Standard Time (EST)Full-TimeSenior
Salary32,000 - 42,000 USD per year
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Job Details
- Experience
- 8+ years of healthcare claims processing, adjudication, reimbursement, payment integrity, claims review, or related healthcare claims operations experience.
- Required Skills
- Project ManagementMicrosoft ExcelQuality Assurance
Requirements
- 8+ years of healthcare claims processing, adjudication, or related operations experience.
- 3-5+ years of experience leading operational teams, supervisors, or quality programs.
- 3-5+ years of direct involvement in claims system implementations, upgrades, and process redesign.
- 3+ years of client-facing experience managing stakeholder expectations and performance reporting.
- Bachelor’s degree in Business Administration, Healthcare Administration, Public Policy, Communications, Technical Writing, or a related field.
- Demonstrated ability to develop SOPs, desk procedures, and training content.
- Strong understanding of the end-to-end healthcare claims lifecycle and provider reimbursement methodologies.
- Proficiency with Microsoft Excel, Word, Teams, Outlook, and SharePoint.
- Ability to analyze complex claims issues and interpret program requirements.
- Strong independent problem-solving and organizational skills in a remote environment.
Responsibilities
- Support the Project Manager with the implementation and startup of healthcare claims operations.
- Define end-to-end claims workflows, operating procedures, handoffs, and escalation paths.
- Develop, document, and maintain standard operating procedures, desk guides, and training materials.
- Serve as a lead-level subject matter expert providing technical guidance on complex claims and payment requirements.
- Support onboarding, mentoring, and coaching for claims processors.
- Monitor claims trends and perform root cause analysis to identify process and quality improvements.
- Participate in requirements reviews, user acceptance testing, and operational readiness activities.
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