Manager, Claims Operations

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $65k - $85k / year

⏰ Full Time

🟠 Senior

🔴 Lead

⚙️ Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Assess and manage claims inventory; track and manage inventory trends and proactively adjust resource levers to maximize productivity and meet inventory management goals • Analyze data and proactively assess business needs • Apply subject matter expertise to claims processing and operations • Manage and coach individual contributor performance and quality using quantitative and qualitative data • Identify and resolve team issues independently, with appropriate escalation • Train and coach staff and vendors on claims processes • Motivate and lead team members in accordance with HealthProof values and objectives • Proactively review and assess talent • Use CMS and regulatory claims processing guidelines to drive compliance with claims processing policies and procedures • Work with Business Analysts and Technical Writers to design and document workflows and business processes • Recommend strategies for attaining and exceeding claims operations SLAs • Recommend training assets and job aids to improve operational effectiveness • Develop and maintain metrics, reports, and tools supporting claims initiatives and personnel • Provide execution and strategic expertise for day-to-day inventory and claims initiatives • Support leadership planning for growth and increased operational efficiency and claims processing quality • Ensure targets, goals, and client expectations are met or exceeded

🎯 Requirements

• A minimum of 7 years of health insurance claims experience with progressive leadership responsibilities • Ability to independently direct the implementation of complex business projects • Working knowledge of other functions within insurance operations and shared services, including benefits, enrolment, compliance, medical management, and customer service • In-depth understanding of industry issues and opportunities and ability to share gained knowledge • Effective communication skills and ability to obtain clear information and remove ambiguity • Capability to approach problems constructively and promote this approach with team members • Well-developed organizational habits • Experience with MS Word, Excel, PowerPoint, and MS Visio • Operating knowledge of Lean Six Sigma and/or AGILE preferred • Candidates may be required to complete a pre-employment criminal background check • Ability to work across multiple time zones in a hybrid or remote work environment • Ability to work long periods sitting and/or standing in front of a computer using video technology

🏖️ Benefits

• Remote work environment • May require travel dependent on company needs • Reasonable accommodations for individuals with disabilities in compliance with the Americans with Disabilities Act of 1990