Manager, Claims Operations

Jobtailor; Deutschland; Hybrid; EUR 90.000 - 130.000; Vollzeit

Zusammenfassung

Jobtailor is seeking an experienced leader to drive health insurance claims operations in Germany. You will oversee inventory management, data-driven decision making, and policy compliance while coaching a team of professionals and vendors to achieve service levels.

The role requires strong analytic skills, cross-functional collaboration, and the ability to work across time zones in a hybrid or remote setup within the health insurance domain.

Qualifikationen

• Minimum 7 years of health insurance claims experience with progressive leadership responsibilities.
• Ability to independently direct the implementation of complex business projects.
• Working knowledge of benefits, enrolment, compliance, medical management, and customer service.
• In-depth understanding of industry issues and opportunities and ability to share gained knowledge.

Aufgaben

• Assess and manage claims inventory; track and manage inventory trends to maximize productivity.
• Analyze data and proactively assess business needs in claims operations.
• Train and coach staff and vendors on claims processes to improve quality.
• Motivate and lead team members in accordance with HealthProof values and objectives.

Kenntnisse

Health Insurance Claims Experience

Leadership Responsibilities

Data Analysis

Regulatory Compliance

Communication Skills

Organizational Skills

Problem-Solving

Coaching and Training

Lean Six Sigma or AGILE Knowledge

Tools

MS Word

MS Excel

MS PowerPoint

MS Visio

Jobbeschreibung

Assess and manage claims inventory; track and manage inventory trends and proactively adjust resource levers to maximize productivity and meet inventory management goals
Analyze data and proactively assess business needs
Apply subject matter expertise to claims processing and operations
Manage and coach individual contributor performance and quality using quantitative and qualitative data
Identify and resolve team issues independently, with appropriate escalation
Train and coach staff and vendors on claims processes
Motivate and lead team members in accordance with HealthProof values and objectives
Proactively review and assess talent
Use CMS and regulatory claims processing guidelines to drive compliance with claims processing policies and procedures
Work with Business Analysts and Technical Writers to design and document workflows and business processes
Recommend strategies for attaining and exceeding claims operations SLAs
Recommend training assets and job aids to improve operational effectiveness
Develop and maintain metrics, reports, and tools supporting claims initiatives and personnel
Provide execution and strategic expertise for day-to-day inventory and claims initiatives
Support leadership planning for growth and increased operational efficiency and claims processing quality
Ensure targets, goals, and client expectations are met or exceeded

Requirements

• A minimum of 7 years of health insurance claims experience with progressive leadership responsibilities
• Ability to independently direct the implementation of complex business projects
• Working knowledge of other functions within insurance operations and shared services, including benefits, enrolment, compliance, medical management, and customer service
• In-depth understanding of industry issues and opportunities and ability to share gained knowledge
• Effective communication skills and ability to obtain clear information and remove ambiguity
• Capability to approach problems constructively and promote this approach with team members
• Well-developed organizational habits
• Experience with MS Word, Excel, PowerPoint, and MS Visio
• Operating knowledge of Lean Six Sigma and/or AGILE preferred
• Candidates may be required to complete a pre-employment criminal background check
• Ability to work across multiple time zones in a hybrid or remote work environment
• Ability to work long periods sitting and/or standing in front of a computer using video technology

Core Competencies

Demonstrates extensive experience in health insurance claims management, with a strong focus on compliance, operational efficiency, and team leadership. Proficient in analyzing data to drive strategic decisions and improve claims processing quality.

Highest-signal resume keywords

• Health Insurance Claims Experience
• Leadership Responsibilities
• Claims Processing Compliance
• Data Analysis and Reporting
• Lean Six Sigma or AGILE Knowledge

ATS Optimization Keywords

Hard Skills

• Claims Processing
• Data Analysis
• Inventory Management
• Performance Management
• Workflow Design
• Metrics Development
• Operational Effectiveness
• Project Implementation
• Regulatory Compliance
• Business Process Improvement

Soft Skills

• Effective Communication
• Problem-Solving
• Team Motivation
• Organizational Skills
• Coaching and Training

Industry Keywords

• Health Insurance
• Claims Operations
• SLA Management
• Customer Service
• Medical Management
• Enrolment
• Compliance

Tools & Technologies

• MS Word
• MS Excel
• MS PowerPoint
• MS Visio