Senior Manager – Member Claims

Senior Manager – Member Claims

Requirements

• 8+ years of experience in operations management, with a focus on customer service, claims adjudication, or similar process-oriented environments.
• At least 5 years of leadership experience, including managing teams through periods of growth, change, and increased complexity.
• Proven track record in scaling operations, managing large teams, and optimizing complex processes.
• Strong leadership skills with experience managing multiple teams and developing senior leaders.
• Strategic thinker with the ability to balance day-to-day operations with long-term planning.
• Excellent problem-solving skills and the ability to navigate complex challenges in a fast-paced environment.
• Analytical mindset with the ability to use data to drive decisions and monitor team performance.
• Strong communication and interpersonal skills, with the ability to influence and collaborate across departments.
• Bachelor’s degree or equivalent experience in a leadership capacity.

Responsibilities

• Own the Member Claims function, including strategic planning, process development, and overall performance management.
• Lead the design, execution, and optimization of key claims adjudication processes that meet evolving business needs.
• Ensure the team meets and exceeds performance targets related to claims accuracy, timeliness, and efficiency.
• Identify long-term strategic initiatives to scale the Member Claims function, supporting company growth and operational excellence.
• Provide thought leadership and solutions to solve complex problems that arise from the rapid growth and complexity of the business.
• Lead and mentor a team of 5+ Team Leaders, ensuring that they have the resources and skills needed to drive team performance.
• Focus on leadership development, coaching, and performance management to ensure Team Leaders are equipped to support and develop their teams.
• Champion a culture of continuous improvement, ensuring all team members contribute to and benefit from opportunities for professional growth.
• Foster a collaborative, high-performance environment that aligns with company values and contributes to organizational success.
• Collaborate closely with other departments (e.g., IT, Operations, Product, and Regulatory) to drive cross-functional projects that impact the broader organization.
• Work with senior leadership and stakeholders to prioritize initiatives and resolve issues that affect Member Claims’ performance and capabilities.
• Lead efforts to integrate innovative solutions, improving both member satisfaction and operational efficiency.
• Continuously analyze claims processes, identifying bottlenecks and inefficiencies, and champion process improvements to streamline workflows.
• Ensure that claims processes are scalable and adaptable to meet the demands of the business as it continues to grow.
• Monitor industry trends and regulatory changes to proactively adapt claims processes, ensuring compliance and best practices are maintained.
• Leverage key performance metrics to monitor team performance and drive accountability.
• Utilize data to make informed decisions, improve claims handling processes, and communicate progress to senior leadership.
• Track trends and key metrics to continuously evolve the Member Claims operation and optimize the member experience.
• Serve as a key member of the Member Services Leadership team, fostering a collaborative culture that emphasizes transparency, accountability, and excellence.
• Promote a positive, inclusive, and high-performing office culture that aligns with [Company Name]’s values and mission.

Preferred Qualifications

No preferred qualifications provided.