Claims Operations Manager – Refund Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the comprehensive modernization of the provider refund ecosystem.

• Create and implement the 'future state' of our refund processing engine, utilizing automation to remove manual touchpoints.

• Serve as a hands-on operator by utilizing our internal toolkit—including AI, automation, and data platforms—to achieve specific recovery outcomes and performance objectives.

• Establish and manage the 'Source of Truth' for program health.

• Develop and maintain BI dashboards to monitor recovery trends.

• Ensure the program's integrity by creating processes that guarantee 100% compliance with CMS regulatory timelines and internal standards.

• Act as the main point of contact between Payment Integrity, Finance, and Product to close feedback loops on overpayment root causes, proactively preventing leakage.

⛳️ Requirements

• Bachelor's degree required, or equivalent experience in a high-growth or regulated setting.

• Demonstrated ability to leverage complex data sets to drive performance and influence organizational results.

• Expertise in BI platforms (e.g., Snowflake, Looker, Tableau) and a history of utilizing LLMs or automation to address business challenges.

• Capability to convert intricate technical or financial concepts into actionable plans for diverse audiences.

• Exceptional attention to detail with the ability to switch between tactical 'in the weeds' tasks and broader goal alignment.

• Experience in healthcare technology, management consulting, or tech operations where you excelled in delivering results within ambiguous environments.

• Proven success in becoming a Subject Matter Expert (SME) in intricate tools or regulatory frameworks to enhance business outcomes.

• Background in fostering collaborative, performance-oriented relationships with cross-functional partners and offshore teams.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plan with low or no premium.

• Generous paid time off.

• $100 monthly mobile or internet stipend.

• Stock options available to all employees.

• Bonus eligibility for all roles, excluding Director and above; Commission eligibility for Sales roles.

• Parental leave program.

• 401K program.

• And more....