Sr. Manager, Claims Operations - Archimedes

Archimedes; Madison (WI); Remote; USD 110,000 - 170,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

401K match

Adoption assistance

Flexible Spending Account

Education assistance

Referral bonus

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Leadership

Claims operations

Healthcare knowledge

Education

Bachelor’s degree in Business Administration or related field

Job description

Overview

Archimedes is seeking a Sr. Manager, Claims Operations to join our team!

The Sr. Manager, Claims Operations is responsible for leading and optimizing end-to-end operational functions, ensuring accurate, timely, and compliant execution of pharmacy benefit services within the claim operations team. This role oversees complex operational workflows, external pharmacy and vendor performance, and cross functional coordination to support client commitments, regulatory requirements, and financial integrity.

The Sr. Manager, Claims Operations acts as both a strategic operator and a hands-on leader, driving process improvement, issue resolution, and operational readiness across direct team and cross-functional teams. Areas of responsibility include claims configuration and processing, claims quality, fee schedule management, direct pharmacy relationship management, copay assistance program oversight, and other critical duties as assigned by leadership.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• 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, quality standards, and business objectives are met, including any claim operations related performance guarantees
• Lead, coach, and develop the team members, including performance management, goal setting, and professional development.
• Ensure operational readiness for new initiatives, implementations, regulatory changes, and ongoing business needs.
• Identify, assess, and mitigate operational risks, and implement corrective actions as necessary.
• Drive continuous process improvement initiatives to enhance efficiency, accuracy, scalability, and quality across all claim operations core functions
• Establish, maintain, and enforce operational policies, procedures, and controls.
• Oversee daily claims QA and related QA processes for configuration, fee schedules and all other quality assurance activities, ensuring appropriate monitoring and reporting mechanisms are in place.
• Collaborate with internal stakeholders and external vendors, including partner pharmacies, to support operational objectives and resolve issues.
• Monitor pharmacy and adjudicator performance against contractual requirements and service level agreements
• Serve as an escalation point for complex or high impact operational issues and drive timely resolution.
• Ensure compliance with applicable laws, regulations, and internal governance standards.
• Support audits, reviews, and remediation activities as required.
• Provide regular operational reporting, insights, and recommendations to senior leadership.
• Communicate operational status, risks, and outcomes clearly to cross functional partners.
• Establish, mentor, and develop team members through coaching, feedback, and career planning, ensuring a pipeline of future leaders and a culture of accountability and growth.
• Participate in, adhere to, and support compliance, people and culture, and learning programs.
• Perform other duties as assigned.

Qualifications

What team expects from you?

• Bachelor’s degree in Business Administration or related field, or equivalent work experience, required.
• 5+ years of claims operations experience required.
• 3+ years of progressive leadership experience, which may include leading individual contributors or teams, or equivalent leadership experience such as coaching, mentoring, or leading complex initiatives or projects, required.
• Experience with specialty claims, configuration and complex programs such as copay assistance strongly preferred.
• Experience in healthcare required.

What can you expect from Archimedes?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!

#LI-Remote

Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.

Equal employment opportunity, including veterans and individuals with disabilities.