Remote Senior Manager, Claims Operations

Archimedes; Madison (WI); Remote; USD 110.000 - 170.000; Vollzeit

Benefits dieser Stelle

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

401K match

Adoption assistance

Flexible Spending Account

Education assistance

Referral bonus

Zusammenfassung

Archimedes is seeking a Sr. Manager, Claims Operations to lead end-to-end claim processing and ensure accurate, timely, and compliant execution of pharmacy benefit services.

You will oversee performance, QA, fee schedule management, and contractor relationships across cross-functional teams. The role drives process improvements, operational readiness for new initiatives, and risk mitigation, while aligning with client commitments and governance standards.

Qualifikationen

• Bachelor’s degree or equivalent work experience required.
• 5+ years of claims operations experience required.
• 3+ years of progressive leadership experience required.
• Experience with specialty claims and copay assistance strongly preferred.
• Experience in healthcare required.

Aufgaben

• Provide leadership and oversight over the claim operations team to ensure efficient, accurate, and compliant execution of business operations.
• Manage day-to-day operational performance, ensuring service levels and quality standards are met.
• Lead, coach, and develop team members including performance management and career development.
• Ensure operational readiness for new initiatives, regulatory changes, and ongoing business needs.
• Identify, assess, and mitigate operational risks and implement corrective actions.
• Drive continuous process improvement to enhance efficiency, accuracy, scalability and quality.
• Oversee QA processes for configuration, fee schedules and related quality activities.
• Collaborate with internal stakeholders and external vendors to meet objectives.
• Monitor vendor performance against contracts and SLAs.
• Serve as escalation point for complex operational issues and drive resolution.
• Ensure compliance with laws, regulations, and governance standards.

Kenntnisse

Leadership

Claims operations

Healthcare knowledge

Ausbildung

Bachelor’s degree in Business Administration or related field

Jobbeschreibung

Archimedes is seeking a Sr. Manager, Claims Operations to lead end-to-end claim processing and ensure accurate, timely, and compliant execution of pharmacy benefit services.

You will oversee performance, QA, fee schedule management, and contractor relationships across cross-functional teams. The role drives process improvements, operational readiness for new initiatives, and risk mitigation, while aligning with client commitments and governance standards.