Manager, Claims Operations

HMA is a third-party health plan administrator seeking a Claims Operations Manager to oversee the end-to-end processing of healthcare claims. The role involves leading the Claims Operations staff, utilizing metrics and forecasting, and driving operational excellence. This is an opportunity to work with a comprehensive benefits package and opportunities for growth.

Requirements

• Bachelor’s Degree or equivalent work experience
• Minimum 5 years’ of claims operations experience
• Minimum 2 years’ experience leading
• Knowledge of CPT, HCPCS, ICD-10 coding, and reimbursement methodologies
• Strong understanding of provider contract terms, fee schedules, and pricing models
• Proven ability to manage and develop a team
• Proactive ability to review talent and recruit talent
• Strong understanding of claims platforms (HealthEdge, Mphasis, or Facets)

Benefits

• Compensation
• Seventeen (IC) days paid time off
• Eleven paid holidays
• Company-paid medical, dental, vision, and prescription insurance
• Voluntary insurances
• HSA and FSA programs
• 401(k) with company match
• Wellness incentive
• Wellness reimbursement
• Remote work
• Continuing education reimbursements
• Discount program
• Parental leave
• Charitable giving match