Manager, Claims Operations

Overview

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.

As a Manager, Claims Operations at UST HealthProof, this is your opportunity to

• 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

You bring:

• 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
• An operating knowledge of Lean Six Sigma and or AGILE, preferred

Geographic Responsibility:  Remote, US

Type of Employment: Full-time, permanent 

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.  

• Work across multiple time zones in a hybrid or remote work environment. 

• Long periods of time sitting and/or standing in front of a computer using video technology. 

• May require travel dependent on company needs. 

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check. 

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. 

#LI-Remote 

**The annual US base salary range for this position is $65,000 to $85,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.