Claims Operations Manager (Payment Accuracy)

TL;DR

Claims Operations Manager (Payment Accuracy): Improving accuracy and strengthening the integrity of end-to-end claims processes with an accent on root cause analysis and systemic process improvement. Focus on investigating operational breakdowns, implementing durable fixes, and leveraging AI agents and LLM-powered tools to automate analyses.

Location: Remote (USA)

Salary: $73,000 - $120,000 / year

Company

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

What you will do

• Conduct deep end-to-end investigations into complex operational issues to identify root causes across people, process, and technology.
• Manage operational queues with high attention to detail, providing well-documented determinations.
• Translate individual errors and anomalies into broader systemic themes and improvement opportunities.
• Partner cross-functionally with Product, Engineering, Compliance, and Finance to implement durable solutions.
• Develop clear documentation, decision frameworks, and feedback loops to prevent issue recurrence.
• Implement AI-driven solutions, including AI agents and LLM workflows, to enhance investigation quality.

Requirements

• Experience in operations, consulting, analytics, or complex problem-solving environments.
• Demonstrated strength in root cause analysis and structured problem solving.
• Ability to derive system-level insights from case-level details.
• Strong analytical skills and comfort using data to identify trends and quantify impact.
• Excellent written and verbal communication skills for explaining complex findings.
• Must be based in the USA.

Nice to have

• Experience in healthcare operations.
• Experience building dashboards or structured issue management processes.
• Hands-on experience with AI tools, automation, or LLM-based workflows in operational settings.

Culture & Benefits

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