Operations Manager - Insurance claims

Location: San Francisco, CA
Job title: Operations Manager
Location: San Francisco, CA
Direct hire
This growing organization is reinventing health insurance through innovative business models, data and analytics to provide personalized care. Join a mission-driven team working together to provide solutions in the complex area of healthcare.
The Insurance Operations teams are working to implement systems that help drive healthy outcomes. This position manages a growing team optimizing service delivery while meeting regulatory compliance.
Job description:
The Operations Manager will drive execution of service design, operational workflows, and delivery in a way that is iterative, data-driven and technology-enabled scalability
-Manage a team of employees responsible for claims monitoring, payment disputes, provider escalations, and benefit and contract configuration
-Develop strategies and drive process improvements
-Partner with Product Managers and Data Engineers to develop tools and automation to improve team efficiency, auto-adjudication rate, and innovate on process execution
-Design and drive process and workflow implementation both internally and with vendors - and act as critical escalation point
-Create and report on key business metrics related to claims including overall quality, timeliness, medical expense and individual productivity metrics
-Ensure compliance with all CMS claims regulations
-Forecast claims volume and required staffing levels to meet quality and timeliness metrics
-Support escalations for claims-related inquiries, both internal and external
Experience and skills:
-Track record of mentoring, developing, and motivating peers and direct reports
-Comfortable analyzing metrics and know how to use data to make better decisions
-Collaborative approach and enjoy working cross-functionally
-Innovate and improve core processes of health insurance - many of which haven't changed in decades
-Thrive in fast-paced, sometimes ambiguous environments and execute efficiently
-2+ years prior experience working in an environment that blends technology and operations
-3+ years of experience in Medicare or Medicare Advantage claims operations/management
-Experience managing large complex teams
Warmest regards,
Aileen Bradley
Addastaff Consulting, Inc.
Senior Technical Recruiter
650-638-9633 x303

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