Hybrid Claims Operations Manager

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About the role

  • Claims Operations Manager building operational functions for a digital claims and rebate platform. Leading daily validation processes and driving automation in partnership with engineering.

Responsibilities

  • Hire, onboard, and manage a small team of Operations Analysts: building workflows, SOPs, escalation paths, and QA frameworks from a blank slate.
  • Own end-to-end claim validation: daily intake, review, approval, denial, and reconciliation, including hands-on management of the Manual Review Queue for claims flagged by logic deviations, data quality issues, or edge cases.
  • Partner with Engineering and Product to translate operational workflows into system requirements and drive the transition from manual processing to scalable automation.
  • Serve as the operational point of contact for veterinary clinics and pharmaceutical manufacturer stakeholders by handling escalations, guiding denial remediation, and reporting on claims trends and program performance.
  • Define and own operational KPIs such as turnaround time, approval/denial rates, accuracy, backlog volume, and build recurring reports, SLAs, and benchmarks for internal leadership and external partners.

Requirements

  • Bachelor's degree in Business Administration, Information Technology, Computer Science, or a related field.
  • 5+ years in claims processing, payment reconciliation, or operations (healthcare, insurance, fintech, or SaaS).
  • 3+ years of people management, which includes hiring, coaching, and performance accountability.
  • Strong grasp of claims adjudication, approval/denial workflows, exception handling, and remediation processes.
  • Experience with Jira Service Management (JSM) for queue management, claims workflows, and SLA tracking.
  • Proven ability to build operational processes from scratch, including SOPs, SLAs, queue management, escalation paths, and QA with no existing playbook.
  • Cross-functional experience working with engineering/product teams to translate ops needs into system requirements.
  • Excellent written and verbal communication across technical and non-technical stakeholders.
  • Serve as a professional point of contact for veterinary clinics and pharmaceutical partners, clearly communicating claim decisions, resolving inquiries, and ensuring a positive and trusted customer experience.

Job title

Claims Operations Manager

Job type

Experience level

Mid levelSenior

Salary

Not specified

Degree requirement

Bachelor's Degree

Location requirements

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