Claims Operations Manager (U.S. Healthcare Claims)

About the role

We are looking for a Claims Operations Manager to lead U.S. healthcare claims operations. The role focuses on driving team performance, ensuring high quality and service levels, managing stakeholder communication, and championing continuous improvement.

Key responsibilities

• Lead daily claims operations to meet accuracy, productivity, quality, and service level targets.
• Coach and monitor a team of 30‑40 claim examiners, handling performance issues and escalations.
• Partner with training and QA teams to improve onboarding, refresher training, and consistency.
• Communicate with clients and stakeholders, manage escalations, and provide timely operational updates.
• Deliver regular business updates on performance, quality, service levels, and improvement actions.
• Drive continuous‑improvement initiatives to reduce errors, delays, and rework.
• Ensure compliance with operational processes, controls, and regulatory requirements.
• Collaborate with cross‑functional teams such as QA, training, workforce management, HR, and client services.

Required profile

• 6+ years of experience in U.S. healthcare claims processing, adjudication, or revenue cycle management.
• 3+ years of leadership experience managing 30‑40 claim examiners.
• Strong understanding of claims workflows, medical terminology, coding concepts, benefits, and payer/provider processes.
• Proven ability to manage productivity, quality, service levels, and team performance in a metric‑driven environment.
• Excellent written and verbal communication skills for client and stakeholder interactions.
• Strong analytical and problem‑solving abilities.

Required skills

• U.S. healthcare claims processing
• Claims adjudication
• Revenue cycle management
• Medical terminology
• Coding concepts
• Benefits and payer/provider processes