Head of Claims

Position Overview

• Location Type: Remote
• Employment Type: Full-Time
• Salary: Not specified
• Description: Angle Health is seeking a Senior-Level Leader to serve as Head of Claims. This role will oversee the full “claims universe” including claims processing, appeals, audits, training, and cost containment. It’s a high-impact leadership role focused on stabilizing and scaling our claims operation as we grow, built from the ground up. The ideal candidate thrives in fast-changing environments and is eager to build a claims organization that’s efficient, compliant, and built to scale.

Requirements

• Minimum of 5+ years of experience in health insurance claims management.
• Preference of 10+ years of health insurance experience.
• Senior leadership experience at a Third Party Administrator (TPA) – large carrier only experience/backgrounds will not be considered.
• Deep knowledge of health insurance claims processing, procedures, and regulatory requirements.
• Excellent leadership and interpersonal skills.
• Proven track record of effective communication and relationship-building.

Responsibilities

• Lead and oversee all core functions related to health insurance claims: processing, auditing, appeals, training, and network/vendor coordination.
• Supervise and mentor a team of approximately 28 claim processors, adjusters, auditors, and appeal coordinators.
• Lead and manage the claims team with a strong sense of urgency, providing clear direction and decisive guidance.
• Build and refine Standard Operating Procedures (SOPs) and operational workflows across the claims lifecycle.
• Conduct performance evaluations and provide training and coaching.
• Foster a positive and productive work environment.
• Oversee the processing of health insurance claims and appeals to ensure accuracy and adherence to company policies and procedures, as well as state and federal regulations.
• Own critical metrics related to accuracy, timeliness, and compliance.
• Review and audit high dollar and complex claims and resolve escalated issues.
• Help refine and scale our claims systems in collaboration with plan building as the company grows.
• Monitor claim trends, utilizing data to target and implement process improvements.
• Develop and implement a comprehensive claims auditing and quality assurance program.
• Stay updated on changes in health insurance laws and regulations to ensure ongoing compliance.
• Work closely with the Care Team to ensure routed service tickets and escalations are handled timely and with a high level of satisfaction.
• Prepare, track, and analyze reports on claim performance.
• Collaborate with other departments to integrate best practices and enhance overall operational efficiency.
• Identify areas of risk or inefficiency and lead corrective action initiatives.
• Play a key role in future strategic planning and team expansion as needed.
• Maintain and report on staffing analytics.
• Other duties as assigned.

Application Instructions

• Not specified.

Company Information

• Company: Angle Health
• Mission: Changing Healthcare For Good by providing accessible, transparent, and easy to navigate digital-first, data-driven health plans.
• Description: Angle Health is replacing legacy systems with modern infrastructure to deliver care to its members.