Manager, Claim Processing

Job Description:

• Manages day-to-day activities of team by providing strategic leadership and overseeing the operations of the claims processing team(s)
• Directs work flow to ensure the efficient and accurate processing of medical claims by establishing and monitoring productivity and quality metrics
• Addresses any complex or escalated claims issues to provide guidance to claim processors in handling challenging cases
• Designs quality control processes to ensure the accuracy and consistency of claim processing
• Assists with the development of the claim processing budget by monitoring expenses and identifying cost-saving opportunities
• Analyzes claim processing data and generates reports to track and evaluate key performance metrics
• Collaborates with other departments to ensure effective communication and coordination in the claim processing workflow
• Ensures compliance with industry regulations and company policies

Requirements:

• 5–7 years of experience in healthcare claims and/or operations
• 5–7 years of demonstrated leadership experience, including team oversight and performance management
• strong execution and delivery capabilities, including planning, implementation, and ongoing support
• strong problem‑solving and sound decision‑making capabilities in complex environments
• proven ability to collaborate effectively across teams and build strong partnerships with diverse stakeholders
• exhibits a growth mindset, including adaptability, continuous learning, and the ability to develop self and others
• strong written and verbal communication skills
• Certified Billing and Coding Specialist (CBCS) preferred
• Candidates located on the East Coast preferred

Benefits:

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• comprehensive benefits package based on eligibility

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