Claims Operations Manager-Operational Transformation

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 a Claims Operations Manager, you will lead the transformation of how we reimburse members for supplemental and medical expenses. 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 reimbursement engine, ensuring every process is built for accuracy and compliance. Your Responsibilities and Impact: System Transformation : Lead the end-to-end modernization of member reimbursement workflows for medical and supplemental expenses. Operational Deployment : Act as a hands-on operator by taking our internal toolkit—including AI, workforce, and data platforms—and deploying them to hit specific business outcomes. Outcome Ownership : Define and own the "Source of Truth" for program health, moving beyond reporting to ensure performance metrics are met or exceeded. Performance Governance : Build and manage BI dashboards to track KPIs, identifying trends and taking immediate corrective action to keep the system on track....