Healthcare Management Administrators · 3 months ago
Manager, Claims Operations
Bellevue, Washington, United States
Full-time
Hybrid
Mid, Senior LevelHealthcare Management Administrators is the premier third-party health plan administrator across the PNW and beyond. The Claims Operations Manager will oversee the end-to-end processing of healthcare claims, leading the Claims Operations staff and ensuring operational excellence in claims intake, pricing, adjudication, and issue resolution.
Health CareInsurance
Responsibilities
Direct supervisory responsibilities: Manages and coaches individual contributor’s performance and quality
Assess and manages claims inventory: Tracks and manages inventory trends and proactively adjusts resource levers as needed to maximize productivity
Manage daily operations of claims processing, ensuring accuracy, timeliness, and compliance with healthcare policies and federal guidelines
Create daily updates for management team flagging production rates, critical issues and areas of escalation in real time
Monitor and resolve pricing discrepancies impacting claims adjudication and provider payments
Lead initiatives to improve pricing workflows, automation, and system performance
Vendor auditing &QA: Leads vendor audits and manages reporting to ensure vendor quality
Apply subject matter expertise to the business of claims processing and operations
Manage to vendor agreements, proactively identify and flag issues, escalate appropriately
Develop and maintain workflows and documentation specific to claims processing
Train and coach staff and vendors on claims processes as needed
Motivate talent: Ability to motivate and lead team members and vendors in accordance with HMA values and objectives
Talent planning: Proactively review and assess talent. Continually develop and/or recruit talent to meet objectives
Qualification
Required
Direct supervisory responsibilities: Manages and coaches individual contributor's performance and quality
Assess and manages claims inventory: Tracks and manages inventory trends and proactively adjusts resource levers as needed to maximize productivity
Manage daily operations of claims processing, ensuring accuracy, timeliness, and compliance with healthcare policies and federal guidelines
Create daily updates for management team flagging production rates, critical issues and areas of escalation in real time
Monitor and resolve pricing discrepancies impacting claims adjudication and provider payments
Lead initiatives to improve pricing workflows, automation, and system performance
Vendor auditing & QA: Leads vendor audits and manages reporting to ensure vendor quality
Apply subject matter expertise to the business of claims processing and operations
Manage to vendor agreements, proactively identify and flag issues, escalate appropriately
Develop and maintain workflows and documentation specific to claims processing
Train and coach staff and vendors on claims processes as needed
Motivate talent: Ability to motivate and lead team members and vendors in accordance with HMA values and objectives
Talent planning: Proactively review and assess talent. Continually develop and/or recruit talent to meet objectives
Benefits
Comprehensive salary
Pay transparency
Benefits
Time off package
Personal development and growth opportunities
Company
Healthcare Management Administrators
HMA is Proving What's Possible in Healthcare®.
Founded in 1986
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Lindsay Harris
Board Member
Recent News
2025-09-30
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