Claims Operations Manager - Remote

Overview

This position is responsible for supporting timely, accurate claim and encounter processing for the claims service teams for all lines of business. Direct reports include exempt and non-exempt staff. Coordination with quality improvement initiatives, supporting ongoing day-to-day production needs, and creative problem-solving are a major focus. Outcomes of this work include continuous improvements in production, efficiency, quality and automation in order to meet and exceed the service expectations of members, providers, employer groups, regulators and auditors.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

In Short

• Responsible for claims processing and management.
• Direct reports include exempt and non-exempt staff.
• Focus on quality improvement initiatives.
• Support day-to-day production needs.
• Creative problem-solving is essential.
• Continuous improvement in production and efficiency.
• Meet service expectations of various stakeholders.
• Work in a patient-focused environment.
• Empower team members for better performance.
• Join a culture of mutual respect and commitment.

Requirements

• Bachelor's Degree in Business Management, Health Care Administration or related field, plus 4 years management/industry experience.
• Associate's Degree in Business Management, Health Care Administration or related field, plus 6 years management/industry experience or 8 years of related management/industry experience.
• 8 years Health Plan Operations and/or Claims Leadership experience.
• 6 years Supervisory experience.
• 2 years track record of developing and implementing automated solutions.

Benefits

• Best-in-class benefits designed to support you and your family.
• Focus on professional growth and financial security.
• Support for staying well and achieving personal goals.
• Opportunity to deliver extraordinary care.