Manager, Claims Research – Analysis

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

📋 Description

• Oversee and assist with claims analysis and research.

• Provide analytical insights to identify process improvements and conduct root cause analyses of issues.

• Design and implement solutions aimed at enhancing the overall efficiency of claims operations.

• Ensure that claims operations meet or surpass established performance metrics.

• Supervise and mentor Claims Business Analysts.

• Gather, validate, and analyze data to provide effective business solutions.

• Track performance and develop as well as implement business solutions to address process and/or quality deficiencies.

• Collaborate with cross-functional teams to deliver solutions utilizing project management skills.

• Advocate for change by sharing best practices.

• Utilize automation to achieve targeted outcomes.

• Engage with and manage all levels of the organization to foster commitment.

• Conduct project analysis for claim adjudication and manage preparation workflows.

• Create and implement necessary Process Bulletins.

• Identify automation opportunities to lower spending levels.

• Decrease adjustment volume through root cause analysis and corrective actions.

⛳️ Requirements

• Must be authorized to work in the U.S. without the requirement for employment-based visa sponsorship, both now and in the future.

• Bachelor's degree in a relevant field or equivalent experience.

• Over 5 years of experience in health plan operations, ideally with Medicare and/or Medicaid or comparable business experience.

• Ability to manage abstract variables and apply logical or scientific reasoning to define problems, gather data, establish facts, and draw valid conclusions.

• Previous experience leading in a functional area, managing cross-functional teams on large-scale projects, or supervisory experience including hiring, training, delegating work, and managing staff performance.

• Must be a resident of Florida.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Employee stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be included in the overall compensation package.

• Equal opportunity employer committed to promoting diversity.