Healthcare Claims Resolution & Compliance Manager

Role Overview 

We are seeking an experienced manager to lead our growing Claims Resolution function. This role requires strong management skills, familiarity with healthcare regulatory processes, and the ability to navigate the interaction between multiple layers of regulatory requirements as they relate to healthcare reimbursement, dispute resolution, and revenue cycle operations. 

The ideal candidate can research, interpret, and apply jurisdiction-specific requirements in a fast-moving environment, and translate complex regulatory information into clear, practical guidance for operational teams. 

The Manager will lead team members and team leads, maintain workflow efficiency, ensure deadlines and quality standards are met, and help the department scale in an organized, effective manner. 

Key Responsibilities 

• Manage daily operations of the Claims Resolution function, ensuring work is completed accurately, efficiently, and on schedule. 
• Oversee team leads and team members, providing direction, accountability, coaching, and support. 
• Develop and maintain workflows, reporting structures, and internal processes to support department growth. 
• Monitor team performance and identify opportunities to improve productivity, quality, consistency, and regulatory compliance. 
• Maintain a strong working knowledge of relevant healthcare regulations, rules, and procedural requirements across multiple jurisdictions. 
• Understand the distinctions, overlap, and potential conflicts between different regulatory frameworks as they relate to healthcare claims and reimbursement disputes. 
• Evaluate which procedural framework applies to a given claim or dispute, and ensure operational procedures reflect the correct process. 
• Research jurisdiction-specific requirements as needed and translate findings into operational guidance, workflows, and training materials. 
• Monitor relevant regulatory developments and assess their operational impact. 
• Coordinate with senior leadership on department performance, staffing, workflow challenges, and strategic priorities. 
• Partner with legal, compliance, and revenue cycle teams on complex or overlapping regulatory questions. 

Requirements 

• Proven managerial experience, preferably overseeing multiple team members or team leads. 
• Ability to manage a fast-paced, high-volume department with strong attention to deadlines and detail. 
• Strong research and analytical skills; ability to interpret and apply regulations and procedural requirements. 
• Familiarity with regulatory frameworks affecting healthcare reimbursement, claims processing, and dispute resolution. 
• Ability to translate regulatory concepts into clear operational procedures. 
• Excellent communication, leadership, and organizational skills. 
• Experience in dispute resolution, legal operations, healthcare compliance, health insurance, revenue cycle management, medical billing, or another regulated healthcare environment strongly preferred. 

Shift Requirements 

Must be able to work a flexible schedule to coordinate with distributed team members across time zones, including some overlap with international team members and availability for leadership check-ins later in the workday, Eastern Time.