Claims Adjudication Manager

Job Summary

To provide hands-on operational leadership for a claims adjudication account, the full-time remote Claims Adjudication Manager will oversee a Philippines-based team, ensuring quality and accuracy in claims processing while serving as the senior operational point of contact for clients.

Key Responsibilities

• Provide day-to-day operational leadership for the Philippines-based adjudication team, directing priorities and removing blockers
• Act as the senior operational single point of contact for the client, consolidating guidance and leading client working sessions
• Own the quality program, reducing errors and closing coaching gaps through targeted feedback and calibration sessions

Required Qualifications

• 6+ years of U.S. healthcare claims adjudication experience, with expertise in both hospital and professional claims
• 3+ years leading claims teams, ideally including offshore or BPO/shared-services teams
• Demonstrated ability to serve as a client-facing operational leader and build client trust
• Strong command of claims workflows, medical terminology, and coding concepts
• Proven track record in managing productivity, quality, and team performance in a metrics-driven environment