Claims Manager
American Family Insurance GroupSalary not specified
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, Healthcare ServicesIndustries
Requirements
Candidates should possess a Bachelor’s degree and a minimum of 8 years of healthcare operations leadership experience, demonstrating deep expertise in healthcare claims operations, including claims adjudication, provider reimbursements, appeals, disputes, and CMS regulations. Proven success in leading and scaling both onshore teams and large offshore/vendor operations is required, alongside strong financial acumen and the ability to manage budgets and operational costs while improving service outcomes.
Responsibilities
As the Director, Claims Operations, you will lead and oversee claims operations across a small onshore team and a large offshore organization, ensuring high-quality, timely, and compliant claims processing. You will serve as the senior subject matter expert in healthcare claims, driving operational excellence, compliance, and innovation. This role involves managing vendor and offshore partnerships, achieving critical enterprise goals, developing and mentoring a high-performing team, collaborating cross-functionally with various teams, identifying and driving process improvements, and leveraging automation, AI, and analytics to optimize workflows and enhance the claims experience. You will also be responsible for traveling internationally up to 10% of the time to engage with offshore teams and partners.
Skills
Healthcare claims
Claims adjudication
Claims payment operations
Vendor management
Quality improvement
AI
Automation
Operational excellence
Team leadership
Regulatory compliance
Devoted Health
Medicare Advantage plans with personalized support
About Devoted Health
Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.
Key Metrics
Waltham, MassachusettsHeadquarters
2017Year Founded
$2,194.5MTotal Funding
SERIES_ECompany Stage
HealthcareIndustries
1,001-5,000Employees