Remote Operations management Jobs • Claims

Responsible for the oversight and management of the claim processing functions related to claims adjudication, appeals, escalations, quality, and recovery. Will have direct management of a team that supports, researches, and resolves the accurate processing of healthcare claims for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement.

The Senior Director of Revenue Cycle Management will oversee all aspects of the revenue cycle, including billing operations, payer integrations, collections, and denial management focusing on optimizing revenue processes, ensuring compliance with regulatory requirements, overseeing revenue cycle technology vendors and fostering relationships with payers to maximize reimbursements.

Lead a team of Claims Processors, ensuring accurate and efficient claims processing for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement. The Claims Supervisor will collaborate with support teams to manage backlog and turnaround times while working with Quality/Training and System Configuration teams to standardize processes and resolve issues. They may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency.

This is a critical position reporting directly to the SVP, A&H. The role is responsible for leading the Customer Service team as well as developing and leading the relationship with our Travel Insurance Division (referred to as INF ) TPA, Robin Assist. The role ensures compliant operation s and collects critical input on product usage to provide insight and recommendations into plan benefits.