Manager, Claims

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Execute a comprehensive service model across various provider segments while ensuring alignment with business objectives.

• Establish performance and process benchmarks for different customer segments.

• Oversee claims submissions, refunds, recovery processes, claims accounting, and financial reporting.

• Enhance shared processing and respond to market trends, capabilities, and customer needs.

• Supervise the collection, preparation, analysis, and reconciliation of financial information.

• Investigate and resolve banking-related issues.

• Engage in projects aimed at optimizing claims processing, recovery, and accounting operations.

• Administer financial recovery efforts, including refunds and collections management.

• Lead team managers and staff while promoting work volume, utilization, and employee engagement.

• Address complex claims appeals by collaborating with relevant stakeholders.

• Work closely with Audit and Payment Integrity teams to ensure accuracy and quality standards are met.

• Create and implement tools and strategies for process enhancements.

• Identify and propose changes in processes and procedures to boost customer satisfaction.

• Negotiate performance guarantees, reviews, approvals, and client RFPs in collaboration with Sales for Claims ASO.

• Act as the Claims ASO subject matter expert and primary contact for performance monitoring and troubleshooting.

• Represent Claims Operations to ASO executives by providing data, reports, analytics, and expert insights.

• Assist the ASO Channel lead with escalations related to Claims, Claims Recovery, and Claims Accounting.

⛳️ Requirements

• Bachelor’s degree or an advanced degree if required.

• Over 8 years of experience in a relevant field.

• Alternatively, 10+ years of experience in a related field may substitute for a degree.

• Proven experience in claims operations within a regulated environment (such as Medicare, government programs, or similar).

• Leadership experience in managing claims teams and overseeing performance management.

• Strong understanding of claims systems and processing workflows.

• Experience in data analytics and reporting.

• Familiarity with Facets or similar claims platforms is highly preferred.

• Must have authorization to work in the United States.

🏝️ Benefits

• Work-life balance, flexibility, and autonomy.

• Comprehensive medical, dental, and vision insurance.

• Health and wellness initiatives.

• Parental leave and support services.

• Assistance with adoption and surrogacy.

• Opportunities for career development.

• Tuition reimbursement for ongoing education.

• 401k matching with an annual company contribution.

• Paid Time Off (PTO).

• Annual Incentive Bonus linked to corporate goal achievements and individual performance.