Claims Operations Manager (U.S. Healthcare Claims)

Claims Operations Manager (U.S. Healthcare Claims)

We are looking for a Claims Operations Manager / Claims Supervisor to lead U.S. healthcare claims operations, with a strong focus on team performance, quality, service levels, stakeholder communication, and continuous improvement. This role is ideal for a people leader with solid experience in healthcare claims, adjudication, or revenue cycle operations who can drive results in a fast-paced, metrics-driven environment.

Key Responsibilities

• Lead daily claims operations to meet accuracy, productivity, quality, and service level goals.
• Manage team performance through coaching, performance monitoring, and issue resolution.
• Partner with training and QA teams to strengthen onboarding, refresher training, accuracy, and consistency.
• Handle client or stakeholder communication, escalations, and operational updates in a timely and professional manner.
• Provide regular business updates on team performance, quality, service levels, and improvement actions.
• Drive continuous improvement initiatives to reduce errors, delays, and rework.
• Ensure adherence to operational processes, controls, and compliance requirements.
• Collaborate with cross-functional teams such as QA, training, workforce management, HR, and client services to support execution.

Must-Have Qualifications

• 6+ years of experience in U.S. healthcare claims processing, adjudication, or revenue cycle management.
• 3+ years of team leadership experience (30-40 Claim Examiners) in healthcare operations, claims, or revenue cycle management.
• Strong understanding of claims workflows, medical terminology, coding concepts, benefits, and payer/provider processes.
• Experience managing productivity, quality, service levels, and team performance in a metric-driven environment.
• Ability to coach team members, manage escalations, and drive issue resolution.
• Strong written and verbal communication skills for client, stakeholder, and internal operations discussions.
• Strong analytical and problem-solving skills.

Preferred Qualifications

• Experience supporting U.S. health plans, TPAs, healthcare BPOs, or shared services operations.
• Exposure to payment review, denials, appeals, or related claims functions.
• Experience supporting training, onboarding, coaching, or capability-building initiatives.
• Exposure to process improvement, automation, or digital transformation initiatives.
• Background in quality assurance, audit, or calibration activities.

Work Setup

Office-based position

Key Competencies

• Operational leadership
• People coaching and performance management
• Quality and service level management
• Client and stakeholder communication
• Analytical thinking and problem-solving
• Continuous improvement and cross-functional collaboration

COMPANY OVERVIEW:

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and

satisfaction with plans’ members and providers. 

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers.  The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.  The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.