Senior Claims Operations Leader (Remote)

Navitus Health Solutions / Lumicera Health Services; United States; Remote; USD 110,000 - 150,000; Full time

Benefits offered by this job

Health insurance

Dental & Vision

PTO 20 days

Parental leave

Holidays 9 days

401K match

Adoption assistance

FSA

Education & membership assistance

Referral bonus

Job summary

Archimedes in the United States is seeking a Sr. Manager, Claims Operations to lead and optimize end-to-end claim operations, ensuring accurate, timely, and compliant processing of pharmacy benefit services.

This role involves strategic oversight of configuration, processing, quality, fee schedules, and vendor management. You will lead and develop the team, drive continuous process improvements, and collaborate with internal stakeholders to meet client commitments, regulatory requirements, and

Qualifications

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

Responsibilities

• Provide leadership over the claims operations team to ensure efficient, accurate, and compliant execution of business operations.
• Manage day-to-day operational performance, ensuring service levels, quality standards, and business objectives are met.
• Lead, coach, and develop the team members, including performance management and career development.
• Ensure operational readiness for new initiatives, implementations, regulatory changes, and ongoing business needs.
• Identify, assess, and mitigate operational risks, implementing corrective actions as necessary.
• Drive continuous process improvement initiatives to enhance efficiency, accuracy, and scalability.
• Establish, maintain, and enforce operational policies, procedures, and controls.
• Oversee daily claims QA and related QA processes for configuration and fee schedules.
• Collaborate with internal stakeholders and external vendors to support objectives.
• Monitor performance against contracts and SLAs, serving as escalation point when needed.
• Ensure compliance with laws and internal governance; support audits and remediation.

Skills

Leadership

Claims operations

Process improvement

Stakeholder collaboration

Healthcare knowledge

Education

Bachelor’s degree in Business Administration or related field

Tools

CRM systems

Analytics tools

Job description

Archimedes in the United States is seeking a Sr. Manager, Claims Operations to lead and optimize end-to-end claim operations, ensuring accurate, timely, and compliant processing of pharmacy benefit services.

This role involves strategic oversight of configuration, processing, quality, fee schedules, and vendor management. You will lead and develop the team, drive continuous process improvements, and collaborate with internal stakeholders to meet client commitments, regulatory requirements, and