Claims Operations Manager

Job Summary

Claims Operations Manager oversees end-to-end claims processing operations in a full-time leadership role, ensuring operational integrity, regulatory compliance, and continuous improvement while managing a multi-functional team.

Key Responsibilities

• Oversee accuracy and efficiency of claims processing operations and manage a team of claims professionals
• Identify and mitigate operational risks while ensuring compliance with federal and state regulations
• Collaborate with cross-functional teams to align claims systems and workflows with organizational goals

Required Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field preferred
• 7-10 years of experience in claims operations, with at least 3-5 years in a leadership role
• Experience managing cross-functional teams in a regulated industry, preferably healthcare or insurance
• Proven track record of building compliance programs aligned with CMS, HIPAA, or state regulations
• Experience with process automation and claims management systems