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Manager, Claims Operations

1 month ago
United States
Full-time
Senior
Operations Manager
Operations
JIRA SQL
Apply Now
Sana Benefits

Sana Benefits

Sana Benefits offers dependable and affordable health insurance solutions for small businesses, including medical, dental, and vision coverage, as well as $0 healthcare options like virtual care and maternity services.

Insurance
251-1K
Founded 2017
$107M raised
View All Jobs

Description

  • Manage and develop a team of Claims and Appeals Processors, providing training, feedback, and performance management to meet SLA and quality targets.
  • Own end-to-end claims operations, including adjudication, appeals, quality assurance, IDR negotiations, and compliance with plan policies and regulatory requirements.
  • Develop and strengthen scalable processes by documenting SOPs, identifying workflow improvements, and leading automation or tooling initiatives to reduce friction and improve accuracy.
  • Manage customer support and provider escalations, partnering with CX, Network Operations, Sales, and Broker teams to resolve issues and represent Claims Operations.
  • Oversee rule-based payment logic and collaborate with Product and Engineering to maintain and enhance the claims rules engine and operational systems (e.g., Jira, internal platforms, reporting tools).
  • Build and maintain plan document infrastructure to ensure operational accuracy, alignment with claims logic and network rules, and regulatory compliance.
  • Serve as the claims subject-matter expert for internal teams, manage vendor relationships, and ensure timely support for Stop Loss reporting and required documentation.
  • Develop KPIs and reporting dashboards to monitor performance, identify trends, and drive continuous operational improvement.
  • Partner on payment integrity and cost-containment programs to reduce waste, ensure appropriate reimbursement, and protect plan assets.
  • Drive cross-functional projects by coordinating requirements, timelines, and stakeholders for system changes, rule updates, plan documents, and process improvements.

Requirements

  • 4+ years of experience in health insurance claims processing with familiarity across institutional and professional claims, coding standards (ICD, CPT/HCPCS, revenue codes), and regulatory requirements.
  • 2+ years of experience managing and developing teams in fast-paced, metrics-driven environments with a track record of building high-performing, accountable teams.
  • Experience documenting SOPs and creating scalable processes, with a startup mindset comfortable creating structure from ambiguity.
  • Strong organizational and time-management skills with the ability to prioritize competing deadlines, manage escalations, and keep multiple workflows moving in parallel.
  • Analytical and data-driven, with experience using spreadsheets and ideally SQL for operational reporting, trend analysis, and KPI development.
  • Excellent verbal and written communication skills with the ability to synthesize data from disparate sources and communicate clearly to technical and non-technical audiences.
  • Gritty problem-solver willing to dive into details and work through complex or ambiguous scenarios to reach clarity.
  • Familiarity with claims operational systems and tooling (e.g., Jira, internal platforms, reporting tools).
  • Stop Loss and Independent Dispute Resolution (IDR) experience is a plus.

Benefits

  • $93,000 - $126,000 annual cash compensation target (US-based remote locations; final offer varies by experience).
  • Fully distributed remote company with no return-to-office mandates.
  • Medical, dental, and vision insurance with 100% company-paid employee coverage.
  • Flexible vacation policy and a culture that encourages using it.
  • 401(k) with company match.
  • Paid parental leave.
  • Competitive stock options offered to all employees.
  • Paid one-month sabbatical after 5 years of employment.

Interested in this position?

Apply directly on the company website

Apply Now

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