Manager, Claims Research & Analysis
Core
Manage claims analysis and research to identify process improvements, root causes, and operational solutions for health plan operations.
Role type
Manager, Claims Operations
Builds
Process improvements, automation solutions, and workflow optimizations for claims delivery
Domain
Health insurance / Medicare & Medicaid operations
Required skills
Claims adjudication analysis, root cause analysis, process improvement, project management, team mentorship, data validation, automation strategy, cross-functional collaboration, performance monitoring
Preferred skills
Experience with Medicare/Medicaid, leading large-scale projects, hiring and training staff
Technologies
None explicitly stated
Responsibilities
Manage and mentor Claims Business Analysts; Collect, validate, and analyze data to deliver business solutions; Monitor performance and implement solutions for process/quality gaps; Utilize project management to work with cross-functional teams; Promote change through best practices; Leverage automation to reduce spend; Interface with organizational levels to mobilize commitment; Perform claim adjudication project analysis and workflow management; Develop Process Bulletins; Reduce adjustment volume through root cause analysis
Seniority
Manager, supervisory level