Senior Manager, Claims Systems

📋 Description

• Oversee institutional and professional claims transactions (837I/837P), investigate ingestion
• Lead accumulator research, reconciliation, transfers, and over-accumulation remediation across
• Oversee system defect triage, Run-The-Business (RTB) gap identification, and adjudication pend rule
• Evaluate end-to-end claims adjudication, benefit hierarchy, plan configuration, and system logic to
• Independently investigate complex claims processing failures, distinguish between operational
• Serve as a technical operational subject matter expert for Product and Engineering, translating

🎯 Requirements

• 10+ years of experience in health insurance operations, third-party administration (TPA), or health
• Strong technical understanding of EDI 837 transactions, clearinghouse exchanges, file ingestion
• Demonstrated expertise in claims adjudication workflows, benefit hierarchy, health plan
• Experience with accumulator reconciliation, cross-benefit transfers, over-accumulation research
• Ability to independently diagnose complex system defects, identify root causes, and translate
• Experience partnering with technical and operational stakeholders to prioritize system

🎁 Benefits

• 135,000 stock options
• Health insurance
• 401k
• Paid time off
• Flexible work arrangements