Manager, Claims Operations - Remote

ZipRecruiter; Chicago (IL); Remote; USD 80,000; Full time

Job summary

Guidehealth, a data-powered healthcare company, seeks a Manager for Claim Operations in Chicago. This role focuses on managing claims production and reporting teams, ensuring operations meet KPIs. Ideal candidates have 3-5 years of management experience in claim operations and strong analytical skills. The position offers a competitive salary and comprehensive benefits including remote work options.

Benefits

Comprehensive health plans

401(k) with employer match

Flexible time off and parental leave

Learning and development resources

Qualifications

• 3-5 years management experience in claim operations.
• Deep knowledge of claims processing and performance metrics.
• Understanding of claims compliance requirements.

Responsibilities

• Managing day-to-day operations of the Claim Operations team.
• Monitoring system performance and implementing improvements.
• Using data analytics to track KPIs and reporting.

Skills

Management experience

Data analysis

Problem-solving

Change management

Communication

Education

Bachelor’s degree in healthcare administration, business, or related field

Tools

Microsoft Office

Eldorado HealthPac Claims Adjudication System

Job description

WHO IS GUIDEHEALTH?

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve patient health, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.

Job Description

As the Manager, Claim Operations, you will play a key role in Guidehealth’s expansion and growth. You will oversee the claims production, inventory, and reporting teams to ensure all KPIs and Metrics are met. This role reports to the Sr. Director, Claims Operations.

WHAT YOU'LL BE DOING

• Managing the day-to-day operations of the Claim Operations team.
• Monitoring system performance, resolving issues, and implementing action plans to improve claims processing operations.
• Assessing workflows, coaching staff, and providing counseling.
• Using data analytics to track KPIs and reporting to leadership regularly.
• Monitoring individual analyst performance, conducting reviews, and providing feedback and mentorship.
• Maintaining desktop procedures for claims processing.
• Identifying process improvements within claims workflows and system tools, designing, and implementing changes.
• Leveraging technology to scale business operations.
• Managing JIRA tickets related to claims inquiries and adjustments.
• Reviewing claims processing on client reports before submission.
• Coordinating workflows with internal departments and participating in policy review meetings.
• Conducting team meetings and attending operational meetings as needed.

QUALIFICATIONS

WHAT YOU'LL NEED TO HAVE

• 3-5 years of management experience in claim operations.
• Skills in managing change and team building.
• Deep knowledge of claims processing, data analysis, and performance metrics.
• Proficiency in Microsoft Office applications.
• Experience with HMO claims, federal and state regulations, and EDI transactions.
• Problem-solving, initiative, and decision-making skills.
• Understanding of claims compliance requirements.
• Ability to meet deadlines, prioritize, and manage projects.
• Independent work capability and good judgment.
• Excellent communication skills.
• Change management experience and a growth mindset.
• Claim coding and edits experience, with CPT and ICD knowledge.

Preferred

• Bachelor’s degree in healthcare administration, business, or related field.
• Knowledge of healthcare regulations, insurance, and reimbursement.
• Certifications like CPB or CPC.
• Experience with Eldorado HealthPac Claims Adjudication System.

The salary for this role is $80,000 per year.

OUR VALUES

At Guidehealth, we are driven by accountability, continuous learning, innovative collaboration, valuing every voice, and practicing empathy in action. These values define our culture and how we thrive together.

BENEFITS

• Remote work with necessary equipment provided.
• Comprehensive health plans.
• 401(k) with employer match.
• Life insurance and voluntary options.
• Employee Assistance Program.
• Flexible time off and parental leave.
• Learning and development resources.

COMPENSATION

Paid bi-weekly, dependent on experience, skills, education, and certifications.

EQUAL OPPORTUNITY

We are committed to diversity and inclusion, ensuring fair employment practices regardless of protected statuses.

DATA PROTECTION

This role requires adherence to security policies to protect PHI, PII, and company data.

REMOTE WORK REQUIREMENTS

Employees need a reliable internet connection (minimum 50 Mbps download, 10 Mbps upload) and the provided equipment to perform their duties effectively.