Manager, Claims Quality – Workforce Readiness

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

📋 Description

• Oversee initiatives related to claims quality enhancement, knowledge management, training, workforce readiness, and performance evaluation.

• Develop and implement a structured quality improvement strategy across Claims Operations.

• Analyze quality insights, operational metrics, and customer feedback to uncover trends, address underlying issues, and minimize recurring errors and rework.

• Collaborate with Quality Assurance and Claims production leaders to implement corrective measures and ensure ongoing operational enhancements.

• Work alongside Claims Optimization, IT, and other departments to utilize automation, analytics, AI, and technological solutions effectively.

• Establish and manage knowledge management, documentation, training, and workforce support across Claims.

• Lead training specialists and collaborate with subject-matter experts to create learning materials and technical support methodologies.

• Prepare staff for new systems, automation, AI-driven workflows, and procedural changes.

• Independently assess Claims operational performance and inventory status.

• Collaborate with Claims production leaders on corrective measures and improvement strategies.

• Leverage quality, performance, and workforce insights to prioritize enhancements and spearhead cross-functional initiatives.

• Build and nurture a team responsible for Claims quality and workforce capabilities.

• Mentor and guide employees through expectations, tasks, feedback, and professional development opportunities.

• Navigate ambiguity and change while establishing the function’s structure, practices, and capabilities.

⛳️ Requirements

• A bachelor's degree or four years of pertinent work experience.

• Seven years of experience in the health plan industry or in business/operational roles.

• Four years of experience in leading and managing teams with direct reports.

• Experience in health plan or healthcare operations, particularly in claims or another high-volume transactional setting.

• Proven track record in managing complex operational functions and achieving measurable enhancements in quality, processes, and performance.

• Experience in establishing structure and capabilities in a dynamic environment.

• Strong ability to lead change, address complex challenges, and foster alignment among teams.

• Proficient in utilizing data, continuous improvement methodologies, technology, automation, analytics, or AI-enabled solutions to elevate operational outcomes.

• Experience in building or managing knowledge management, training, workforce readiness, or operational performance programs.

🏝️ Benefits

• Medical, vision, and dental insurance with low employee premiums.

• Optional benefits such as pet insurance.

• Life and disability insurance coverage.

• Retirement plans, including a 401K employer match and a pension plan that vests after three years of service.

• Wellness incentives, including access to counseling services, stress management programs, and mindfulness initiatives.

• Generous paid time off policy.

• Tuition assistance for both undergraduate and graduate degrees.

• Employee recognition initiatives.

• Flexibility for hybrid employees, providing access to on-site resources, networking opportunities, and team engagement activities.

• Commuter benefits.

• Free on-site parking for convenience.

• Subsidized on-campus cafes.

• On-site events such as health and wellness activities, coffee connects, and disaster preparedness fairs.

• Access to a fitness and well-being center offering both in-person and virtual workouts and nutritional counseling.