Manager, Claims Operations

November 26

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Sana

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Healthcare Insurance • SaaS • B2B

Sana is a company providing modern health benefits tailored specifically for small businesses. The company offers comprehensive health plans which include medical, dental, and vision coverage, along with $0 healthcare options like virtual care, maternity, labs, and imaging services. Sana aims to simplify the management of health benefits, offering features like real-time employee management and transparent claims viewing. With a focus on affordability, businesses can save up to 20% by choosing Sana, with a high rate of renewal among clients. Their service includes a dedicated team of medical and benefits experts to assist members with guidance and in-network referrals. Sana emphasizes strong customer support with high satisfaction ratings, ensuring employees can keep their preferred providers without incurring out-of-network fees. The company prides itself on being a reliable and budget-friendly option for small businesses.

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

💰 $60M Series B on 2022-06

📋 Description

• Manage and develop a team of Claims and Appeals Processors, providing training, feedback, and performance management to ensure SLA and quality targets are consistently met • Own end-to-end claims operations, including adjudication, appeals, QA, IDR negotiations, and compliance with plan policies and regulatory requirements • Develop and strengthen scalable processes by documenting SOPs, identifying workflow improvements, and leading automation or tooling initiatives that reduce friction and improve accuracy • Manage customer support and provider escalations, partnering closely with CX, Network Operations, Sales, and Broker teams to resolve issues efficiently and represent Claims Operations with professionalism and clarity • Oversee rule-based payment logic, collaborating with Product and Engineering to maintain and enhance our claims rules engine and operational systems (Jira, internal platforms, reporting tools, etc.) • Build and maintain plan document infrastructure ensuring operational accuracy, alignment with claims logic and network rules, and regulatory compliance • Serve as claims subject-matter expert for internal teams, manage vendor relationships, and ensure timely support for Stop Loss reporting and required documentation. • Develop KPIs and reporting dashboards to monitor performance, uncover trends, and drive continuous operational improvement • Partner on payment integrity and cost containment programs, leveraging data and vendor partnerships to reduce waste, ensure appropriate reimbursement, and protect plan assets • Drive cross-functional projects, coordinating requirements, timelines, and stakeholders for system changes, rule updates, plan documents, and process improvements

🎯 Requirements

• 4+ years of experience in health insurance claims processing, with strong familiarity across institutional and professional claims, coding standards (ICD, CPT/HCPCS, revenue codes), and regulatory requirements • 2+ years managing and developing teams in fast-paced, metrics-driven environments, with a track record of building high-performing, accountable teams • Exceptionally organized with strong time-management skills, able to prioritize competing deadlines, manage escalations, and keep multiple workflows moving in parallel • Process-builder with a startup mindset and who is comfortable creating structure from ambiguity, documenting SOPs, and improving systems while adapting quickly to change • Gritty problem-solver who’s willing to dive into the details, ask foundational questions, and work through complex or ambiguous scenarios to get to clarity • Excellent verbal and written communication skills, with the ability to synthesize data from disparate sources, tell a clear story, and communicate effectively to both technical and non-technical audiences • Analytical and data-driven, with experience in spreadsheets and (ideally) SQL to support operational reporting, trend analysis, and KPI development • Stop Loss and Independent Dispute Resolution (IDR) experience is a plus, but not required.

🏖️ Benefits

• Remote company with a fully distributed team – no return-to-office mandates • Flexible vacation policy (and a culture of using it) • Medical, dental, and vision insurance with 100% company-paid employee coverage • 401k w/ company match • FSA, and HSA plans • Paid parental leave • Short and long-term disability, as well as life insurance • Competitive stock options are offered to all employees • Transparent compensation & formal career development programs • Paid one-month sabbatical after 5 years • Stipends for setting up your home office and an ongoing learning budget • Direct positive impact on members’ lives – wait until you see the positive feedback members share every day