Senior Claims Operations Manager

HealthEdge; United States; Remote; USD 65,000 - 85,000; Full time

Job summary

HealthEdge is seeking a Manager I, Claims Operations to lead and optimize claims processing and inventory across remote US teams. You will shape performance metrics, drive efficiency, and guide a growing team while aligning with company goals and regulatory standards.

The role requires 7+ years in health insurance claims with leadership experience, strong analytics, and the ability to coach staff and vendors across multiple time zones in a hybrid/remote environment.

Qualifications

• 7+ years of health insurance claims experience with leadership responsibilities.
• Ability to lead complex business projects independently.
• Familiarity with insurance operations functions (benefits, enrollment, compliance, medical management, customer service).
• Strong communication to clarify expectations and resolve issues.

Responsibilities

• Assess and manage claims inventory and trends; adjust resources to meet goals.
• Analyze data to identify business needs and opportunities.
• Apply SME knowledge to claims processing and operations.
• Coach and develop staff and vendors using metrics and quality data.
• Identify and escalate team issues and drive solutions.
• Train staff on claims processes and workflows; mentor teammates.
• Lead by example in HealthProof values and objectives.
• Ensure compliance with CMS and regulatory guidelines.

Skills

Leadership

Claims operations

Data analysis

Communication

Project management

Cross-functional collaboration

Lean Six Sigma knowledge

Tools

MS Word

MS Excel

MS PowerPoint

MS Visio

Job description

HealthEdge is seeking a Manager I, Claims Operations to lead and optimize claims processing and inventory across remote US teams. You will shape performance metrics, drive efficiency, and guide a growing team while aligning with company goals and regulatory standards.

The role requires 7+ years in health insurance claims with leadership experience, strong analytics, and the ability to coach staff and vendors across multiple time zones in a hybrid/remote environment.