Manager of Claims Operations

📋 Description

• Lead daily claims processing for timely, accurate adjudication.
• Develop end-to-end claims processes (adjudication, pend, payment).
• Optimize inventory management with KPI reporting.
• Manage complex/high-dollar claims and escalations.
• Analyze claims data to report metrics and risks.
• Drive process improvements and ensure regulatory compliance.

🎯 Requirements

• Bachelor's Degree or equivalent experience
• Subject matter expertise in medical claims and end-to-end processes
• 5+ years in claims, including team leadership
• Strong understanding of self- and level-funded health plans
• Strong problem-solving skills
• Commitment to outstanding member experiences
• Excellent communication and collaboration skills
• Extra credit: startup experience and Javelina claims system

🎁 Benefits

• Alternative medicine coverage
• Flexible PTO
• Up to 16 weeks paid parental leave
• Paid holidays
• 401k program
• Education reimbursement