Manager, Claims Operations

Team Management:

• Manage and develop a team of Claims and Appeals Processors.
• Provide training, feedback, and performance management to ensure targets are met.
• Build high-performing, accountable teams.

Operational Excellence:

• Own end-to-end claims operations, including adjudication, appeals, and compliance.
• Develop scalable processes by documenting SOPs and identifying workflow improvements.
• Oversee rule-based payment logic and maintain our claims rules engine.

Cross-functional Collaboration:

• Manage customer support and provider escalations, partnering closely with CX, Network Operations, Sales, and Broker teams.
• Drive cross-functional projects, coordinating requirements, timelines, and stakeholders.
• Serve as a claims subject-matter expert for internal teams and manage vendor relationships.