Manager, Claims Operations

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

📋 Description

• Evaluate and oversee claims inventory; monitor and analyze inventory trends while proactively adjusting resource allocations to enhance productivity and achieve inventory management objectives.

• Examine data and proactively determine business requirements.

• Utilize subject matter expertise in claims processing and operational functions.

• Supervise and mentor the performance and quality of individual contributors using both quantitative and qualitative metrics.

• Independently identify and address team challenges, escalating issues when necessary.

• Educate and guide staff and vendors on claims procedures.

• Inspire and lead team members in alignment with HealthProof’s values and goals.

• Proactively evaluate and assess talent.

• Implement CMS and regulatory claims processing standards to ensure adherence to claims processing policies and procedures.

• Collaborate with Business Analysts and Technical Writers to develop and document workflows and business processes.

• Suggest strategies for achieving and surpassing claims operations Service Level Agreements (SLAs).

• Propose training resources and job aids to enhance operational efficiency.

• Create and maintain metrics, reports, and tools that support claims initiatives and personnel performance.

• Provide execution and strategic guidance for daily inventory and claims projects.

• Assist leadership in planning for growth, operational efficiency, and the quality of claims processing.

• Ensure that targets, objectives, and client expectations are met or exceeded.

⛳️ Requirements

• A minimum of 7 years of experience in health insurance claims with increasing leadership responsibilities.

• Ability to independently lead the execution of complex business projects.

• Familiarity with various functions within insurance operations and shared services, including benefits, enrollment, compliance, medical management, and customer service.

• Comprehensive understanding of industry challenges and opportunities, with the capability to share acquired insights.

• Strong communication skills with the ability to gather clear information and eliminate ambiguity.

• Ability to approach challenges constructively and encourage this mindset among team members.

• Well-established organizational skills.

• Proficiency in MS Word, Excel, PowerPoint, and MS Visio.

• Preferred knowledge of Lean Six Sigma and/or AGILE methodologies.

• Candidates might need to undergo a pre-employment criminal background check.

• Capability to work across multiple time zones in a hybrid or remote work setting.

• Ability to spend extended periods sitting and/or standing in front of a computer utilizing video technology.

🏝️ Benefits

• Remote work setting.

• May require travel based on company requirements.

• Reasonable accommodations for individuals with disabilities in compliance with the Americans with Disabilities Act of 1990.