Manager, Claims Operations
About The Position
HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com. At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members. UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth. UST HealthProof is looking for a Manager I, Claim Operations. The Claims Operations Manager I is responsible to develop and maintain metrics/reports/tools to support various claim initiatives and personnel. The Manager will provide execution and strategic expertise to support day to day inventory and claims initiatives’ success. The Manager will service as an integral part of the leadership team to help strategically plan for growth and develop ways to increase optimal operational efficiencies and quality of claims processing. Ensuring targets, goals and client expectations are met or exceeded.
Requirements
- A minimum of 7 years of health insurance claims experience with progressive leadership responsibilities
- An ability to independently direct the implementation of complex business projects
- Working knowledge of other functions within insurance operations and shared services (benefits, enrolment, compliance, medical management, customer service etc.)
- Possesses an in-depth understanding of industry issues and opportunities and is able to share gained knowledge.
- Effective communications: ability to obtain clear information and remove ambiguity as needed to arrive at shared expectations
- Capability to approach problems as challenges and deal with them constructively; promoting this approach with all team members
- Well-developed organizational habits
- Experience in MS Word, Excel, PowerPoint, MS Visio
Nice To Haves
- An operating knowledge of Lean Six Sigma and or AGILE, preferred
Responsibilities
- Assess and manage claims inventory; track and manage inventory trends and proactively adjusts resource levers as needed to maximize productivity to meet inventory management goals
- Be solutions oriented; analyze data, proactively assesses business needs
- Apply subject matter expertise to the business of claims processing and operations
- Manage and coach individual contributor performance and quality using quantitative and qualitative data
- Independently identify and resolve team issues with appropriate escalation
- Train and coach staff and vendors on claims processes
- Motivate and lead team members in accordance with HealthProof values and objectives
- Proactively review and assess talent
- Use knowledge of CMS and regulatory claims processing guidelines to drive compliance in HealthProof claims processing policies and procedures
- Work with Business Analysts and Technical Writers to design and document workflows and business processes
- Recommend strategies for attaining and exceeding claims operations SLAs
- Recommend training assets and job aids to improve operational effectiveness
Benefits
- Health insurance
- Dental insurance
- Vision insurance
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
