Sana · 2 months ago
Manager, Claims Operations
United States
Full-time
Remote
Mid, Senior Level
$93K/yr - $126K/yr
4+ years expSana Benefits is a health plan solution company focused on making healthcare easy. The Claims Operations Manager will lead the claims processing team, ensuring accurate and timely claims processing while developing scalable processes and team members.
Employee BenefitsHealth CareInsurance
Responsibilities
Manage and develop a team of Claims and Appeals Processors, providing training, feedback, and performance management to ensure SLA and quality targets are consistently met
Own end-to-end claims operations, including adjudication, appeals, QA, IDR negotiations, and compliance with plan policies and regulatory requirements
Develop and strengthen scalable processes by documenting SOPs, identifying workflow improvements, and leading automation or tooling initiatives that reduce friction and improve accuracy
Manage customer support and provider escalations, partnering closely with CX, Network Operations, Sales, and Broker teams to resolve issues efficiently and represent Claims Operations with professionalism and clarity
Oversee rule-based payment logic, collaborating with Product and Engineering to maintain and enhance our claims rules engine and operational systems (Jira, internal platforms, reporting tools, etc.)
Build and maintain plan document infrastructure ensuring operational accuracy, alignment with claims logic and network rules, and regulatory compliance
Serve as claims subject-matter expert for internal teams, manage vendor relationships, and ensure timely support for Stop Loss reporting and required documentation
Develop KPIs and reporting dashboards to monitor performance, uncover trends, and drive continuous operational improvement
Partner on payment integrity and cost containment programs, leveraging data and vendor partnerships to reduce waste, ensure appropriate reimbursement, and protect plan assets
Drive cross-functional projects, coordinating requirements, timelines, and stakeholders for system changes, rule updates, plan documents, and process improvements
Qualification
Required
4+ years of experience in health insurance claims processing, with strong familiarity across institutional and professional claims, coding standards (ICD, CPT/HCPCS, revenue codes), and regulatory requirements
2+ years managing and developing teams in fast-paced, metrics-driven environments, with a track record of building high-performing, accountable teams
Exceptionally organized with strong time-management skills, able to prioritize competing deadlines, manage escalations, and keep multiple workflows moving in parallel
Process-builder with a startup mindset and who is comfortable creating structure from ambiguity, documenting SOPs, and improving systems while adapting quickly to change
Gritty problem-solver who's willing to dive into the details, ask foundational questions, and work through complex or ambiguous scenarios to get to clarity
Excellent verbal and written communication skills, with the ability to synthesize data from disparate sources, tell a clear story, and communicate effectively to both technical and non-technical audiences
Analytical and data-driven, with experience in spreadsheets and (ideally) SQL to support operational reporting, trend analysis, and KPI development
Preferred
Stop Loss and Independent Dispute Resolution (IDR) experience is a plus, but not required
Benefits
Remote company with a fully distributed team – no return-to-office mandates
Flexible vacation policy (and a culture of using it)
Medical, dental, and vision insurance with 100% company-paid employee coverage
401k w/ company match
FSA, and HSA plans
Paid parental leave
Short and long-term disability, as well as life insurance
Competitive stock options are offered to all employees
Transparent compensation & formal career development programs
Paid one-month sabbatical after 5 years
Stipends for setting up your home office and an ongoing learning budget
Direct positive impact on members’ lives – wait until you see the positive feedback members share every day
Company
Sana
Sana makes healthcare simpler, more affordable, and higher quality for small and midsize businesses.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
$106.76MKey Investors
Gigafund
2022-06-15Series B· $60M
2021-10-25Series A· $20M
2020-09-09Series A· $20.8M
Leadership Team
Will Young
CEO & Co-founder
N
Nathan Hackley
Co-Founder
Recent News
Liquid 2 Ventures
2025-02-25
2023-12-22
The Information
2023-12-22
Company data provided by crunchbase