Healthcare Claims Technical Operations Manager
About The Position
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Healthcare Claims Technical Operations Manager in United States. This role provides the opportunity to lead and optimize claims ingestion operations within a fast-paced healthcare technology environment. The manager will oversee a Center of Excellence responsible for ensuring accurate, timely, and high-quality claims processing across multiple clients. You will drive standardization, operational best practices, and continuous improvement while serving as the enterprise subject matter expert for claims ingestion, EDI validation, and system troubleshooting. This position requires strong leadership skills to mentor and scale teams, coordinate cross-functional efforts, and manage incident resolution with efficiency and precision. The ideal candidate thrives in a hybrid or remote environment, collaborates across time zones, and ensures operational excellence while maintaining clear communication with internal and external stakeholders.
Requirements
- Bachelorâs degree in business, healthcare, or technical field, or equivalent experience.
- 6+ years of experience managing mid- to large-scale healthcare claims operations or production support teams.
- Deep knowledge of healthcare payer claims, EDI transactions (837, 270/271, 276/277, 835), and claims intake workflows.
- Experience with healthcare payer platforms (e.g., Facets, QNXT, NASCO) and service management tools (Jira, ServiceNow).
- Strong SQL skills; familiarity with ETL, cloud platforms (AWS/GCP), or HealthEdge applications preferred.
- Proven ability to manage high-severity incidents, drive operational excellence, and lead distributed teams.
- Excellent communication, planning, coordination, and documentation skills.
Nice To Haves
- ITIL knowledge or certification preferred; experience in onshore/offshore delivery models is a plus.
Responsibilities
- Build, lead, and mentor a Claims Ingestion Center of Excellence responsible for enterprise-wide claims intake.
- Establish performance standards, operational KPIs, and quality benchmarks for the COE.
- Oversee daily claims ingestion operations, including EDI transactions, SNIP edits, validation, and troubleshooting.
- Develop and implement standardized processes, templates, SOPs, and best-practice frameworks across clients.
- Manage ingestion incidents, conduct root cause analysis, and ensure timely resolution of system and data issues.
- Collaborate with vendors, EDI partners, and internal teams to resolve data and system challenges.
- Provide reporting, trend analysis, and SLA updates to leadership and clients, driving transparency and continuous improvement.
Benefits
- Competitive salary range: $110,000 â $130,000 per year.
- Comprehensive healthcare coverage including medical, dental, and vision.
- Paid time off and holidays.
- Retirement plan options.
- Professional development and training opportunities.
- Flexible work environment with remote options.
- Opportunities to work on high-impact healthcare technology initiatives.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
