Claims Configuration Senior Manager
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Job Summary
Owning the accuracy and strategic direction of claims back-end logic, the full-time Claims Configuration Senior Manager will manage auto-adjudication strategies, contract group matching, and EOB/EOP logic while working remotely.
Key responsibilities
- Develop and optimize auto-adjudication strategies to enhance operational metrics and reduce manual reviews
- Serve as the subject matter expert on claims matching to provider contracts, resolving discrepancies and ensuring compliance
- Oversee the logic for generating member EOBs and provider EOPs, ensuring clarity and compliance with CMS requirements
Required qualifications
- 6+ years of experience in business operations or operational leadership
- Strong analytical skills with experience in building KPIs and working with large claims datasets
- Demonstrated success in driving operational change in fast-paced environments
- Exceptional communication skills for explaining complex claims logic to diverse audiences
- Comfort with ambiguity and a willingness to engage deeply with complex claims system logic
Complete Job Description
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