Claims Operations Manager (Healthcare)

TL;DR

Claims Operations Manager (Operational Transformation): Lead the end-to-end modernization of member reimbursement workflows for medical and supplemental expenses with an accent on system transformation, operational deployment using AI and data platforms, and performance governance. Focus on defining program health metrics, building BI dashboards for KPIs, and engineering processes for full compliance.

Location: Remote USA

Salary: $73,000 - $125,000 / year

Company

Healthcare company combining health insurance, clinical care, service, and technology to deliver integrated solutions for older Americans.

What you will do

• Lead modernization of reimbursement workflows for medical and supplemental expenses.
• Deploy internal toolkit including AI, workforce, and data platforms to achieve business outcomes.
• Define and own source of truth for program health and performance metrics.
• Build and manage BI dashboards to track KPIs and take corrective actions.
• Engineer processes ensuring 100% compliance with regulations.

Requirements

• Operator mindset: focus on execution with quantifiable milestones.
• Proven analytical skills using complex data sets to drive outcomes.
• Proficiency with BI platforms like Snowflake, Looker, Tableau; experience with LLMs or automation.
• Ability to translate complex concepts into actionable plans.
• Extreme organization balancing tactical and strategic tasks.
• Bachelor’s degree or equivalent experience in high-growth or regulated environments.

Nice to have

• Background in healthcare technology, management consulting, or tech-ops.
• Expertise in complex tools or regulatory frameworks.
• Experience building relationships with cross-functional and offshore teams.

Culture & Benefits

• Employer-sponsored health, dental, vision plans with low/no premiums.
• Generous paid time off and parental leave.
• 401K program, stock options, bonus eligibility.
• $100 monthly mobile/internet stipend.