Claims Operations Supervisor (Healthcare)

TL;DR

Claims Operations Supervisor (Healthcare): Leading U.S. healthcare claims operations to ensure accuracy, productivity, and service level adherence with an accent on team performance management and stakeholder communication. Focus on driving continuous improvement initiatives, resolving complex escalations, and optimizing adjudication workflows.

Location: Onsite in Makati, Metro Manila, Philippines

Company

hirify.global is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide.

What you will do

• Lead daily claims operations to meet accuracy, productivity, quality, and service level goals.
• Manage team performance for 20-30 Claim Examiners through coaching and performance monitoring.
• Partner with training and QA teams to strengthen onboarding, accuracy, and consistency.
• Handle client and stakeholder communication, including escalations and operational updates.
• Drive continuous improvement initiatives to reduce errors, delays, and rework.
• Ensure strict adherence to operational processes, controls, and compliance requirements.

Requirements

• 4+ years of experience in U.S. healthcare claims processing, adjudication, or revenue cycle management.
• 2+ years of team leadership experience managing a team of 20-30 Claim Examiners.
• Strong understanding of claims workflows, medical terminology, coding concepts, and payer/provider processes.
• Experience managing productivity, quality, and SLAs in a metric-driven environment.
• Strong written and verbal communication skills for professional stakeholder discussions.

Nice to have

• Experience supporting U.S. health plans, TPAs, or healthcare BPOs.
• Exposure to payment review, denials, appeals, or related claims functions.
• Experience with process improvement, automation, or digital transformation initiatives.
• Background in quality assurance, audit, or calibration activities.