HealthEdge · 1 month ago
COE Manager (Tech Ops)
United States
Full-time
Remote
Mid, Senior Level
$110K/yr - $130K/yr
6+ years expHealthEdge is a technology company that provides services for health plans. They are seeking a COE Manager to lead the Claims Ingestion Center of Excellence, ensuring accurate and timely claims intake while driving continuous improvement across processes and operations.
Enterprise SoftwareHealth CareProduct DesignSoftware
Responsibilities
Build, lead, and mentor a Claims Ingestion Center of Excellence responsible for enterprise-wide claims intake
Define staffing plans and oversee hiring, onboarding, and capability development
Establish performance standards, operational KPIs, and quality benchmarks for the COE
Serve as the enterprise SME for claims ingestion, including SNIP edits, validation logic, provider/EDI rules, and common transaction defects
Oversee daily ingestion operations ensuring all claims are successfully received, validated, and loaded into the claims systems
Lead complex troubleshooting across ingestion pipelines, EDI gateway issues, companion guide variances, and partner/vendor data errors
Ensure consistent application of business rules, system edits, and SNIP level requirements
Develop and implement standardized ingestion processes, templates, SOPs, and best-practice frameworks across all clients
Define and enforce enterprise ingestion SLAs and quality controls
Monitor ingestion trends to identify systemic issues, gaps, and improvement opportunities
Drive resolution and root cause analysis for ingestion incidents, defects, and load failures
Oversee the management of ingestion-related tickets in Jira/ServiceNow, ensuring accuracy, prioritization, and timely triage
Partner with vendors, EDI trading partners, and upstream/downstream system owners to resolve ingestion, translation, or formatting issues
Participate in internal Change Approval Boards for ingestion-impacting changes
Represent UST HealthProof at client Change Approval Boards for ingestion readiness, risks, and approvals
Provide operational metrics, trend analysis, and SLA reporting to leadership and customers
Lead customer calls focused on ingestion performance, issue status, and optimization opportunities
Qualification
Required
Bachelor's degree in a business or technical field, or equivalent experience
6+ years of experience managing a mid- to large-scale production support or operations environment
Deep experience with healthcare payer claims, including SNIP levels, EDI validation, and claims intake workflows
Strong expertise with EDI transactions, particularly 837, 270/271, 276/277, and 835
Experience working with healthcare payer platforms such as Facets, QNXT, NASCO, or similar
Strong knowledge of service management tools such as Jira Service Management and ServiceNow
Strong experience supporting high-governance and compliance-controlled environments
Ability to manage Sev1/Sev2 ingestion incidents with confidence and urgency
Experience with SQL required; experience with ETL, SOAP, cloud platforms (AWS/GCP), and HealthEdge applications is a plus
Proven experience leading teams, driving process improvement, and establishing operational best practices
Experience working in an onshore/offshore delivery model
Strong communication skills and the ability to interact effectively with peers, vendors, customers, and leadership
Strong planning, coordination, and documentation skills
Preferred
ITIL knowledge or certification preferred
Company
HealthEdge
HealthEdge Software offers benefits administration and care management software solutions.
1001-5000 employees
H1B Sponsorship
HealthEdge has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (45)
2024 (37)
2023 (35)
2022 (56)
2021 (35)
2020 (34)
Funding
Current Stage
Late StageTotal Funding
$97.78MKey Investors
MedicaOaktree Specialty LendingPsilos Group
2025-04-08Acquired
2020-03-09Private Equity
2017-07-14Series Unknown· $34M
Leadership Team
A
Alex Saltzman
Chief of Staff to the CEO & Senior Vice President of Corporate Development
Kevin Adams
Chief Executive Officer
Recent News
2025-12-06
Precedence Research
2025-11-21
Company data provided by crunchbase