Remote Claims Operations Manager - Data-Driven Leader

F-Prime Capital; United States; On-site; USD 65,000 - 85,000; Full time

Job summary

HealthEdge seeks a Manager, Claims Operations to lead claims processing and inventory management in a remote US setting. You will develop metrics, reports, and tools to support claim initiatives and guide the team toward operational excellence.

Responsibilities include coaching, data-driven decision making, and ensuring regulatory compliance while collaborating with analysts and writers to optimize workflows and SLAs.

Qualifications

• 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.)
• Possesses an in-depth understanding of industry issues and opportunities and is able 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 as challenges and deal with them constructively; promoting this approach with all team members
• Well-developed organizational habits

Responsibilities

• Assess and manage claims inventory; track and manage inventory trends and proactively adjusts resource levers as needed 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

Leadership

Data analysis

Communication

Problem solving

Collaboration

Organizational skills

Tools

MS Word

MS Excel

PowerPoint

MS Visio

Lean Six Sigma

AGILE

Job description

HealthEdge seeks a Manager, Claims Operations to lead claims processing and inventory management in a remote US setting. You will develop metrics, reports, and tools to support claim initiatives and guide the team toward operational excellence.

Responsibilities include coaching, data-driven decision making, and ensuring regulatory compliance while collaborating with analysts and writers to optimize workflows and SLAs.