Remote Claims Operations Leader

HealthEdge Software, Inc.; Northern (KY); Hybrid; USD 65,000 - 85,000; Full time

Job summary

HealthEdge Software, Inc. through UST HealthProof is hiring a Manager I, Claims Operations to lead claims processing and inventory management across remote U.S. teams, develop metrics, and drive operational efficiency.

You will partner with analysts and vendors to ensure timely, accurate claims handling and policy compliance. Applicants should have 7+ years in health insurance claims with progressive leadership, strong communication, and experience with CMS guidelines.

Qualifications

• 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 (benefits, enrolment, compliance, medical management, customer service etc.).
• Understanding of industry issues and opportunities and the ability to share gained knowledge.
• Effective communications: ability to obtain clear information and remove ambiguity as needed to arrive at shared expectations
• Capability to approach problems constructively; promoting this approach with all team members
• Well-developed organizational habits.
• Experience in MS Word, Excel, PowerPoint, MS Visio
• An operating knowledge of Lean Six Sigma and or AGILE, preferred

Responsibilities

• Assess and manage claims inventory; track inventory trends and proactively adjust resource levers to maximize productivity to meet inventory management goals
• Be solutions oriented; analyze data, proactively assesses business needs
• Apply subject matter expertise to the business of claims processing and operations
• Manage and coach individual contributor performance and quality using quantitative and qualitative data
• Independently identify and resolve team issues 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 knowledge of CMS and regulatory claims processing guidelines to drive compliance in HealthProof 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

Skills

Claims leadership

Data analysis

CMS knowledge

Communication

Lean Six Sigma/AGILE

Remote teamwork

Staff coaching

Tools

MS Word

MS Excel

PowerPoint

MS Visio

Job description

HealthEdge Software, Inc. through UST HealthProof is hiring a Manager I, Claims Operations to lead claims processing and inventory management across remote U.S. teams, develop metrics, and drive operational efficiency.

You will partner with analysts and vendors to ensure timely, accurate claims handling and policy compliance. Applicants should have 7+ years in health insurance claims with progressive leadership, strong communication, and experience with CMS guidelines.