Appeals & Claims Operations Lead

ADP, Inc.; Washington (District of Columbia); On-site; USD 80,000 - 110,000; Full time

Job summary

ADP, Inc. in Washington, DC seeks two Appeals & Claims Operations Administrators to oversee end-to-end claims appeals workflow.

You will supervise staff workloads, monitor quality and productivity, and refine processes to ensure timely, compliant outcomes across multiple product lines. Responsibilities include directing clinical, legal, and administrative reviews, producing regular operational reports, and coordinating with client contacts to clarify expectations and deadlines while driving

Qualifications

• Bachelor’s degree preferred; an Associate degree with strong relevant experience will be considered.
• Prior experience with health plans, TPAs, or healthcare legal/consulting organizations, specifically in Appeals & Grievances, Claims Operations, or Quality/Compliance.
• Proven experience supervising or coordinating teams and workflows (formal people-management experience strongly preferred).
• Familiarity with Medicaid, CMS, and/or marketplace/Exchange regulations is preferred.
• Strong communication, organizational, and time-management skills, with the ability to manage multiple priorities and stakeholders.
• Comfort working in a fast-paced, metrics-driven environment and learning new systems and processes quickly.

Responsibilities

• Lead and supervise day-to-day operations of the appeals and grievances workflow, ensuring cases are assigned, tracked, and completed within required timeframes.
• Oversee staff who conduct clinical, legal, and administrative reviews of appeals, providing direction, feedback, and coaching to maintain consistency and quality.
• Monitor queues, aging, and turnaround times; proactively resolve bottlenecks and escalate issues that could impact service-level agreements.
• Implement and maintain standardized procedures, templates, and work instructions in alignment with federal and state regulations, client policies, and internal quality standards.
• Collaborate with internal leadership and client contacts to clarify expectations, refine processes, and address operational issues.
• Develop, review, and distribute regular reports on volumes, outcomes, timeliness, and quality metrics for appeals and grievances.
• Support onboarding and ongoing training of team members on workflows, documentation standards, and regulatory or policy updates.
• Participate in audits and quality reviews; identify root causes of errors and lead corrective-action plans.

Skills

Team leadership

Workflow management

Regulatory compliance

Education

Bachelor's degree

Associate degree

Job description

ADP, Inc. in Washington, DC seeks two Appeals & Claims Operations Administrators to oversee end-to-end claims appeals workflow.

You will supervise staff workloads, monitor quality and productivity, and refine processes to ensure timely, compliant outcomes across multiple product lines. Responsibilities include directing clinical, legal, and administrative reviews, producing regular operational reports, and coordinating with client contacts to clarify expectations and deadlines while driving