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Collective Health · 9 hours ago

Manager, Member Claims

Plano, TX

Full-time

Hybrid

Mid, Senior Level, Lead/Staff

$95K/yr - $118K/yr

8+ years exp

Collective Health is transforming how employers and their people engage with their health benefits through cutting-edge technology and compassionate service. The Manager, Member Claims oversees the Member Claims General Processing Teams, ensuring the accuracy and efficiency of medical claims processing while leading a team and fostering a positive work culture.

Health CareHealth InsuranceInsurTech

Responsibilities

Lead, coach, and develop a team of early-career Team Leaders who manage Member Claims Associates

Build leadership capability through structured coaching, performance feedback, and targeted professional development plans

Model high-quality leadership behaviors that reinforce accountability, ownership, curiosity, and member-first thinking

Foster a positive, collaborative, and inclusive team culture aligned with Collective Health values

Fully own the Member Claims function; including strategy, process development, execution, and KPI achievement

Ensure accurate, timely, and compliant medical claims processing across all workstreams, maintaining high performance standards in accuracy, timeliness, and efficiency

Oversee day-to-day operational execution including staffing, workload distribution, quality assurance, up-training, and issue resolution

Monitor key operational, quality, and productivity metrics; leverage performance insights to drive continuous improvement, accountability and execute operational excellence

Identify, prioritize, and lead strategic initiatives that improve scalability, reduce complexity, and enhance the member experience

Champion process improvement efforts that streamline workflows, reduce variation, and support long-term efficiency

Collaborate closely with cross-functional partners (Network, Regulatory, Compliance Engineering, Member Advocacy, Quality Assurance, etc.) to resolve escalations, address root causes, and build scalable solutions

Represent Member Claims as a key leader within the larger health plan operations team partnering with internal and external business partners

Participate in, and at times, lead cross-functional initiatives that improve system capabilities, support new products, or evolve our operating model

Influence stakeholders to ensure buy-in for operational changes and broader claims-related initiatives

Maintain rigorous quality assurance standards to ensure claims are processed accurately, compliantly, and consistently

Lead investigation of complex and escalated claims issues, identifying root causes, trends, and emerging risks

Own end-to-end correction and resolution, including claim rework, remediation, and implementation of corrective actions

Drive timely escalation resolution in partnership with cross-functional teams and ensure fixes are durable and prevent recurrence

Qualification

Healthcare operations experiencePeople managementProcess improvementAnalytical skillsCross-functional leadershipCoachingTeam developmentCommunication skills