Claims Operations Manager

Job Description

• As a Claims Operations Manager, you will lead a talented team in evaluating, adjudicating, and auditing claims to ensure compliance with policies and regulatory requirements. Your role will drive performance, manage staffing, and implement quality improvement initiatives. You will also oversee the coordination of benefit (COB) processes, including collecting COB data from members, documenting primary and secondary benefits, and processing claims. • Lead and mentor a team of claims processors, providing coaching, development, and performance management to ensure high standards of efficiency and accuracy • Develop and implement COB strategies and policies to optimize claims processing and improve member and provider satisfaction • Review and analyze COB-related claims to identify discrepancies, ensure compliance with regulations, and resolve complex issues • Drive quality and performance metrics for the processing team • Ensure timely and compliant processing of claims according to standard operating procedures • Develop and implement strategies to enhance key performance indicators (KPIs) such as processor volume per hour, claims quality, automation rate, and hand-off reduction • Collaborate with cross-functional teams to introduce and integrate new processes • Manage additional projects as needed

Qualifications

• 2+ years of proven experience in managing teams, including coaching and performance management • 4+ years of experience in claims processing, with a focus on coordination of benefits (COB) • Demonstrated ability to drive quality and performance improvements within a claims environment • Experience managing high volumes of work and the proven ability to prioritize effectively based on SLAs or turnaround time requirements • Excellent communication and interpersonal skills, with the ability to collaborate effectively with cross-functional teams • Willingness and ability to work in a fast-paced startup environment • Bachelor's degree • Healthcare/insurance experience (Preferred) • Medical coding experience (Preferred)

Benefits

• Competitive salary, bonus opportunity, and equity package • Comprehensive Medical, Dental, and Vision benefits • A 401k retirement plan • Paid vacation and company holidays • Opportunity to make an impact at a rapidly growing mission-driven company transforming healthcare in the U.S