Manager, Claims Operations

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November 25

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HealthEZ

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Healthcare Insurance • B2B • HR Tech

HealthEZ is a third-party administrator that designs and administers self-funded employee health benefit plans for employers and brokers. The company focuses on customized plan design, cost containment (including reference-based pricing and prescription management), provider network management, and 24/7 member support, backed by mobile and online tools to improve member experience and reduce healthcare spending.

51 - 200 employees

Founded 1982

⚕️ Healthcare Insurance

🤝 B2B

👥 HR Tech

📋 Description

• Oversee the day-to-day claims operational processes, including inventory management of claims, to meet quality and timeliness standards • Responsible for the data integrity of the claims system to ensure files are received and processed • Responsible for developing, maintaining, and training written policy and procedures for claims processing • Define team and individual KPIs and manage the team to execute the operational strategy and annual goals • Identify and Implement improvements to create capacity, reduce claims inventory, increase auto adjudication rate, improve quality, reduce the cost of a claim, and maximize claims compliance efforts • Provide monthly reporting with accompanying analysis of operating metrics and performance measures for all claims operations areas

🎯 Requirements

• Degree in business, health care, or public healthcare administration • 3 years’ experience with people management responsibilities • 3+ years’ experience in Supervising/Management of a claims Operational team in a fast-paced, transactional based environment • Claims adjudication platform configuration experience • Experience with vendor data connectivity management • Experience in the administration of self-funded TPA healthcare plans preferred • Experience with Virtual Benefits Administrator (VBA) preferred • Experience with stop loss management, flexible spending, and HRA/HSA administration preferred

🏖️ Benefits

• Health benefits • Retirement plan (401k) • Paid time away • Paid leaves (including paid parental leave)