Manager, Claims Operations - Remote

Overview

The Manager, Claims Operations at Guidehealth will oversee the claims production and inventory reporting teams, ensuring operational excellence and meeting key performance indicators.

In Short

• Manage the daily operations of the Claim Operations team.
• Monitor and improve claims processing operations.
• Utilize data analytics for KPI tracking.
• Conduct performance reviews and coaching for team members.
• Maintain desktop procedures for claims processing.
• Identify and implement process improvements.
• Distribute and manage JIRA tickets for claims inquiries.
• Participate in policy and procedure committee meetings.
• Conduct team meetings and attend operational meetings.

Requirements

• 3-5 years of management experience in claims operations.
• Skills in team building and change management.
• Advanced knowledge of claims processing and data analysis.
• Proficient in Microsoft Office applications.
• Experience with HMO Medical insurance claims.
• Knowledge of EDI transactions.
• Strong problem-solving and decision-making skills.
• Understanding of compliance requirements in claims processing.
• Project management experience.
• Exceptional communication skills.

Benefits

• Fully remote work environment.
• Comprehensive medical, dental, and vision plans.
• 401(k) plan with employer match.
• Life and disability insurance.
• Employee assistance program (EAP).
• Flexible time off for work-life balance.
• Paid parental leave.
• Resources for professional growth and development.