Claims Operations Manager (U.S. Healthcare Claims)

TL;DR

Claims Operations Manager (U.S. Healthcare Claims): Leading daily claims operations and team performance for U.S. healthcare accounts with an accent on accuracy, productivity, and service level management. Focus on coaching a large team of examiners, driving continuous improvement initiatives, and ensuring strict adherence to operational compliance and stakeholder communication.

Location: Office-based in Makati, Metro Manila

Company

hirify.global is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans, utilizing their proprietary JetStream workflow platform to process millions of claims annually.

What you will do

• Lead daily claims operations to meet accuracy, productivity, and service level goals.
• Manage team performance through coaching, monitoring, and issue resolution for 30-40 Claim Examiners.
• Partner with training and QA teams to strengthen onboarding and operational consistency.
• Handle client and stakeholder communication, escalations, and operational updates.
• Drive continuous improvement initiatives to reduce errors, delays, and rework.
• Ensure adherence to operational processes, controls, and compliance requirements.

Requirements

• 6+ years of experience in U.S. healthcare claims processing, adjudication, or revenue cycle management.
• 3+ years of team leadership experience managing 30-40 Claim Examiners.
• Strong understanding of claims workflows, medical terminology, coding concepts, and payer/provider processes.
• Proven ability to manage productivity, quality, and service levels in a metric-driven environment.
• Strong analytical, problem-solving, and communication skills.
• Must be able to work onsite in Makati, Philippines.

Nice to have

• Experience supporting U.S. health plans, TPAs, or healthcare BPOs.
• Exposure to payment review, denials, appeals, or audit activities.
• Background in process improvement, automation, or digital transformation.

Culture & Benefits

• Opportunity to work with a mission-critical partner to over 70 U.S. health plans.
• Exposure to innovative workflow technology and digital transformation initiatives.
• Collaborative environment working across QA, training, and workforce management teams.