Claims Operations Manager

Job Summary

Managing the day-to-day operations of the Claims Appeals, Claims Medical Review, and Subrogation Teams, the full-time remote Claims Operations Manager will implement best practices, monitor performance metrics, and provide leadership to enhance team productivity.

Key responsibilities

• Oversee the management of services provided by the Claims Appeals, Claims Medical Review, and Subrogation Teams, ensuring operational efficiency
• Prepare reporting and analysis consistent with defined standards, while identifying strategic opportunities based on financial analysis
• Lead, coach, and develop team members, providing guidance, training, and performance feedback to promote maximum performance

Required qualifications

• Bachelor's degree or equivalent work experience required
• At least 5 years of TPA or group health insurance experience, with a minimum of 3 years in a supervisory role
• In-depth knowledge of claims, benefits, and administrative processes
• Intermediate proficiency in Microsoft Office applications, including Word, Excel, Access, and PowerPoint
• Ability to write business correspondence and procedures effectively