Claims Operations Manager
Description
The Claims Operations Manager is responsible for overseeing the end-to-end claims processing function within a healthcare payer environment. This role ensures accurate, timely adjudication of claims, drives process improvements, and manages vendor relationships to optimize operational efficiency and service quality. The ideal candidate brings strong knowledge of healthcare claims workflows, a continuous improvement mindset, and experience working in fast-paced operations environments.
Claims Operations & Oversight
- Manage daily claims operations, including intake, adjudication, adjustments, and issue resolution
- Ensure claims are processed accurately, efficiently, and in compliance with regulatory and internal guidelines
- Monitor key performance indicators (KPIs) such as turnaround time, accuracy, and backlog
Process Improvement & Optimization
- Identify inefficiencies and implement process improvements to enhance product...