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US

  • Lead the modernization of the provider refund ecosystem and design the future state of the refund processing engine.
  • Act as a hands-on operator, deploying tools like AI, automation, and data platforms to hit recovery outcomes.
  • Define and own the "Source of Truth" for program health, ensuring recoupment targets are met and leakage is eliminated.

Automation Healthcare Technology Management Consulting Analytics

18 jobs similar to Claims Operations Manager for Refund Checks

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$70,000–$110,000/yr
US

  • Oversee, manage, and continue to iterate on end-to-end delivery of Devoted’s card-based and supplemental benefit offerings to drive a compliant and financially optimal member experience.
  • Set and monitor KPIs for card-based and supplemental benefit administration and delivery.
  • Partner cross-functionally with Devoted Member Experience, Guide, Integration Ops, and tech teams to drive improvement.

Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. Founded in 2017, they've grown fast and now serve members across the United States.

US

  • Build end-to-end reporting solutions in data management and visualization tools specific to the health system business.
  • Redesign operational workflows, especially around reporting and performance tracking, to replace manual and error-prone processes.
  • Partner with IT and Engineering to ensure clean data pipelines and translate business needs into clear technical requirements.

Natera is a global leader in cell-free DNA testing focused on oncology, women's health, and organ health to enable earlier and more targeted interventions. The company consists of dedicated professionals from world-class institutions who work hard and grow quickly in a collaborative environment that is changing genetic disease management.

$150,000–$195,000/yr
US Unlimited PTO

  • Own the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations.
  • Design and oversee a robust audit program that monitors adjudication system output against clinical policies, pricing, benefit rules, and provider contract terms.
  • Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies and contract validation.

Clover Health aims to improve the health of its members by leveraging technology and data-driven insights to provide personalized, high-quality care. They are a mission-driven team of individuals, who are passionate about solving healthcare's most complicated problems, and strive to put members first.

$98,000–$107,000/yr
US 16w maternity 16w paternity

  • Lead the resolution of complex financial and benefits billing escalations to ensure accurate member financial tracking.
  • Perform root-cause analysis on multi-system issues, coordinate corrective actions, and reconcile claims data across platforms.
  • Act as the primary bridge between internal and external teams to clarify issues and expedite resolutions while communicating clearly with members.

Maven Clinic is the world's largest virtual clinic for women and families, providing clinical, emotional, and financial support through its digital platform across fertility, maternity, parenting, and menopause care. It is an award-winning, mission-driven company trusted by over 2,000 employers and health plans, with a culture recognized for innovation and as a great place to work.

$110,000–$122,000/yr
US Unlimited PTO 10w maternity

  • Research and document new payment integrity concepts by analyzing medical policies, billing regulations, and reimbursement logic.
  • Translate complex billing rules into precise technical specifications for automated claim auditing algorithms.
  • Conduct hands-on data analysis using Microsoft Excel to explore datasets and quantify savings potential for clients.

Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. They work with over 660,000 providers and handle over 12 million prior authorization requests annually. The Coherenauts who succeed here are empathetic teammates who are candid, kind, caring, and embody their core values and principles.

$243,200–$304,000/yr
US

  • Own Omada’s end-to-end commercial operating system (planning, pipeline, forecasting, compensation, tooling, and governance) to support scalable growth.
  • Lead, coach, and inspire a high-performing Commercial Operations organization setting clear charters and success metrics.
  • Define and execute a coherent AI strategy for Commercial Operations, using AI to improve pipeline insights and rep productivity.

Omada Health is reverse engineering the way healthcare is delivered in America, putting the space between doctor visits–where health is won or lost–at the center of care. Omada has served more than two million members since launch across 2,000+ employers, health plans, pharmacy benefit managers, and health systems.

$145,000–$195,000/yr
US Unlimited PTO

  • Define and evolve a practical support operations roadmap aligned to company priorities.
  • Own the structure and ongoing optimization of Salesforce Service Cloud.
  • Build reporting that provides visibility into support demand, trends and product pain points.

Model N is the leader in revenue optimization and compliance for pharmaceutical, medtech, and high-tech innovators. They have helped over 150 customers maximize revenue, streamline operations, and maintain compliance. They are located across more than 120 countries.

$130,000–$140,000/yr
US Unlimited PTO

  • Own day-to-day People Operations including onboarding, offboarding, and documentation.
  • Operate as the power user across InMarket's HR technology stack, leading configuration and integration.
  • Build and maintain executive-level dashboards covering headcount, retention, and performance trends.

InMarket is a leader in 360-degree consumer intelligence and real-time activation for top brands. They utilize a data-driven marketing platform to build targeted audiences, activate media in real-time, and measure success, with a commitment to diversity and inclusion.

US Unlimited PTO

  • Define and own the claims technology product roadmap.
  • Lead discovery efforts by digging into data and user research.
  • Drive end-to-end delivery with your dedicated engineering team.

Kin makes life simpler and more affordable for homeowners, especially in areas with climate risks and outdated systems. They focus on providing smarter homeowners insurance and expanding to meet all homeowner needs, utilizing data, technology, and thoughtful support.

$149,600–$195,000/yr
US

  • You will lead the evolution of our billing systems to support increasingly complex products, pricing models, and customer contracts.
  • Collaborating with revenue cycle, accounting, engineering, commercial and operational teams, you will gain a deep understanding of the diverse needs and motivations of Omada’s customer segments.
  • You will use AI and machine learning to deliver solutions in new and innovative ways.

Omada Health is reverse engineering the way healthcare is delivered in America, putting the space between doctor visits–where health is won or lost–at the center of care. Omada’s virtual-first model combines human-led care teams, connected devices, and AI-enabled technology to deliver personalized care at scale. The company has a culture of trust, seeking context, acting boldly, delivering results, and succeeding together.

US

  • Define and maintain the AI and workflow automation roadmap for People Operations, prioritizing use cases based on business value and feasibility.
  • Design, build, and deploy AI and automation solutions in partnership with People Tech and IT, ensuring they meet security, compliance, and user experience standards.
  • Monitor performance dashboards, lead continuous improvement of workflows, and measure impact through key metrics in collaboration with the People Insights Manager.

TKO Group Holdings is a premium sports and entertainment company that owns iconic properties like UFC and WWE. It is a large, globally-focused organization with a dynamic culture that partners with major sports rights holders through its subsidiaries.

US

  • Define and prioritize Carda's product roadmap for the top of the funnel to drive significant increases in patient enrollment and activation.
  • Build, deploy, and experiment with AI-driven solutions and agents to automate tasks, augment staff, and scale therapy delivery across the United States.
  • Manage the end-to-end product development lifecycle with a focus on workflow automation, Salesforce integrations, and removing bottlenecks in the activation funnel.

Carda Health is a rapidly growing digital health company that provides engaging, compassionate, and life-saving virtual therapy for heart and lung patients from home. The company is a team of clinicians, mathematicians, repeat entrepreneurs, and engineers backed by top investors in the digital health space.

$165,000–$185,000/yr
US Unlimited PTO

  • Lead core Revenue Operations functions across Sales Operations, Client Success Operations, and Deal Desk.
  • Lead the design, standardization, documentation, and continuous improvement of core go-to-market processes.
  • Deliver accurate, timely dashboards, executive reporting, and actionable insights across sales performance, customer retention, forecast risk, conversion trends, and productivity.

SugarAI is redefining CRM for the age of AI. They are delivering on the original promise of CRM—turning fragmented customer and revenue signals into clear, prioritized action. They are a global team united by a shared commitment to impact, ownership, and continuous growth.

US

  • Translates business requirements into business solutions and acts as a liaison between OIA staff and DIS staff.
  • Leads medium to high complexity projects by creating and managing project plans and delivering regular status updates.
  • Designs and implements business process improvements and workflow automations to streamline data flows and improve efficiency.

Medical College of Wisconsin (MCW) brings together minds in science, medicine, education and community engagement to tackle challenges in health and society. With around 1,600 faculty and approximately 3,500 employees, MCW is home to a diverse group of thought leaders.

$109,000–$135,000/yr
US

  • Own and optimize the marketing automation platform (Pardot) and CRM (Salesforce), including integrations, segmentation, and compliance with data regulations.
  • Build and maintain dashboards and reporting to track KPIs, pipeline performance, and campaign ROI, delivering actionable insights.
  • Partner with Demand Generation, Sales, and RevOps teams to align on goals and enable them with tools, training, and documentation.

Horizon3.ai is a fast-growing remote cybersecurity company focused on enabling organizations to proactively find, fix, and verify exploitable attack vectors through its NodeZero autonomous penetration testing platform. The team consists of former U.S. Special Operations cyber operators, startup engineers, and cybersecurity practitioners, fostering a culture of respect, collaboration, ownership, and results.

US

  • Own the product vision and roadmap for Ceresti’s internal Dementia Management Platform.
  • Translate company goals around operational scalability, cost savings, and care quality into clear product priorities.
  • Design systems that enable ops teams and coaches to operate efficiently at scale.

Ceresti aims to reduce avoidable hospitalizations and improve care for people living with dementia, enhancing the lives of their families and caregivers. They are a tech-enabled dementia care provider with a differentiated model of care, fostering a culture rooted in agility, innovation, and collaboration.

US

  • Owns the design, evolution, and execution of the AI forward Care Teams Management System, to ensure Care Teams verticals operate as a single, integrated system.
  • Accountable for operational performance, efficiency, quality, and outcomes for the Care Teams Management System and its horizontal functions.
  • Foster a culture of continuous improvement across Care Teams by building engagement, shared ownership, and passion for better ways of working.

Omada Health is reverse engineering healthcare to deliver personalized care at scale, supporting chronic conditions outside of doctor visits. The company has served over two million members across 2,000+ employers, health plans, and health systems, and is certified as a Great Place to Work, striving for an inclusive culture.

US

  • Responsible for processing insurance claims accurately and efficiently.
  • Analyze claim data to identify trends, errors, and potential irregularities.
  • Serve as a liaison between departments to support seamless claims resolution and continuous process improvement.

Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. They are a fast-growing company serving over 200,000 seniors in 1,500+ communities across 32 states.