Claims Operations Manager - Refund Management

Job description

Job Description A Bit About This Role: We are on a journey to modernize and transform our entire claims system end-to-end . As the Claims Operations Manager for Refund Checks, you will lead the transformation of how we recover, reconcile, and manage provider overpayments. We are looking for a high-impact operator —someone who doesn’t just suggest ideas but owns the high-stakes operational ecosystem. You will be responsible for the health, scalability, and performance of our refund engine, ensuring every dollar recovered is handled with 100% accuracy and strict regulatory compliance. You are a builder who takes messy, manual workflows and transforms them into automated, high-performing, and audit-ready engines. Your Responsibilities and Impact: System Transformation : Lead the end-to-end modernization of the provider refund ecosystem. Design and deploy the "future state" of our refund processing engine, leveraging automation to eliminate manual touchpoints. O perational Deployment : Act as a hands-on operator by taking our internal toolkit—including AI, automation, and data platforms—and deploying them to hit specific recovery outcomes and performance targets. Outcome Ownership : De...