Claims Operations Senior Manager (Healthcare)

TL;DR

Claims Operations Senior Manager (Healthcare): Improving payment accuracy and resolving systematic issues throughout the claims lifecycle with an accent on AI-native workflow design and operational scalability. Focus on designing the next generation of policies and processes, leveraging AI agents and automation to optimize the claims engine.

Location: Remote (USA)

Salary: $105,000 - $150,000 / year

Company

A comprehensive healthcare company combining insurance, clinical care, and technology to improve the health and well-being of older Americans.

What you will do

• Identify and resolve systemic issues and vulnerabilities throughout the claims lifecycle to improve payment accuracy.
• Design and implement AI-native workflows, policies, and processes to enhance consistency and speed.
• Partner with Product, Engineering, and Data teams to align operational needs with the technical roadmap.
• Lead the organization through operational evolution and change management.
• Execute a modernization roadmap while maintaining high-quality standards and stability.

Requirements

• At least 5 years of experience in complex operational environments with a record of delivering measurable results.
• Proven ability in systems thinking to turn complex processes into repeatable business workflows.
• Strong analytical skills and proficiency in using complex data sets to drive strategic initiatives.
• Outstanding communication and influence skills for partnering with senior leadership.
• Must be based in the USA.
• Bachelor's degree or equivalent work experience.

Nice to have

• Experience deploying AI-enabled workflows or automation to solve business challenges.
• Passion for experimentation and continuous learning.

Culture & Benefits

• Comprehensive employer-sponsored health, dental, and vision plans.
• Generous paid time off and parental leave program.
• 401K program and stock options for all employees.
• Monthly $100 stipend for mobile or internet.
• Bonus eligibility for the role.