Manager of Payer Operations

Job Summary

A company is looking for a Manager, Payer Operations (Remote).

Key Responsibilities

• Establish and monitor performance metrics for payer data feeds and define standard operating procedures for data issue triage
• Serve as the primary point of escalation for high-priority payer data issues and collaborate with cross-functional teams
• Oversee documentation processes for HEDIS and ensure compliance with healthcare regulations and data security standards

Required Qualifications

• Bachelor's degree in Healthcare Administration, Data Analytics, Information Systems, or a related field, or equivalent experience
• 5+ years of experience in healthcare data operations, payer relations, or health informatics, with at least 2-4 years in a leadership role
• Advanced proficiency in SQL for data investigation and familiarity with data observability tools
• Deep understanding of payer data structures and healthcare quality reporting
• Proven ability to lead teams through complex technical troubleshooting and manage high-volume issue queues