Claims Operations Manager U S Healthcare Claims

Claims Operations Manager (U.S. Healthcare Claims)

We are looking for a Claims Operations Manager / Claims Supervisor to lead U.S. healthcare claims operations, with a strong focus on team performance, quality, service levels, stakeholder communication, and continuous improvement. This role is ideal for a people leader with solid experience in healthcare claims, adjudication, or revenue cycle operations who can drive results in a fast-paced, metrics-driven environment.

Key Responsibilities

• Lead daily claims operations to meet accuracy, productivity, quality, and service level goals.
• Manage team performance through coaching, performance monitoring, and issue resolution.
• Partner with training and QA teams to strengthen onboarding, refresher training, accuracy, and consistency.
• Handle client or stakeholder communication, escalations, and operational updates in a timely and professional manner.
• Provide regular business updates on team performance, quality, service levels, and improvement actions.
• Drive continuous improvement initiatives to reduce errors, delays, and rework.
• Ensure adherence to operational processes, controls, and compliance requirements.
• Collaborate with cross-functional teams such as QA, training, workforce management, HR, and client services to support execution.

Must-Have Qualifications

• 6+ years of experience in U.S. healthcare claims processing, adjudication, or revenue cycle management.
• 3+ years of team leadership experience (30-40 Claim Examiners) in healthcare operations, claims, or revenue cycle management.
• Strong understanding of claims workflows, medical terminology, coding concepts, benefits, and payer/provider processes.
• Experience managing productivity, quality, service levels, and team performance in a metric-driven environment.
• Ability to coach team members, manage escalations, and drive issue resolution.
• Strong written and verbal communication skills for client, stakeholder, and internal operations discussions.
• Strong analytical and problem-solving skills.

Preferred Qualifications

• Experience supporting U.S. health plans, TPAs, healthcare BPOs, or shared services operations.
• Exposure to payment review, denials, appeals, or related claims functions.
• Experience supporting training, onboarding, coaching, or capability-building initiatives.
• Exposure to process improvement, automation, or digital transformation initiatives.
• Background in quality assurance, audit, or calibration activities.

Work Setup

Office-based position

Key Competencies

• Operational leadership
• People coaching and performance management
• Quality and service level management
• Client and stakeholder communication
• Analytical thinking and problem-solving
• Continuous improvement and cross-functional collaboration