Operations Manager

Summary

Curative is seeking a dynamic healthcare insurance Operations Manager to lead our claims operations, ensuring accuracy, compliance, and efficiency. You’ll combine deep industry knowledge with data-driven insights to optimize workflows and drive process automation. Your role will be pivotal in reducing cycle times, controlling costs, and delivering exceptional service to internal and external stakeholders. The key expectations, competencies, and requirements for the successful candidate are outlined below.

Essential Duties And Responsibilities

• This position is located on-site in Austin, Texas.
• Successfully manages the day-to-day operations of the Curative Claims Team to achieve top performance
• Manage a team of claims specialists, providing coaching, performance feedback, and professional development opportunities.
• Develop and oversee end-to-end claims processing workflows, ensuring adherence to regulatory requirements and internal SLAs.
• Leverage advanced analytics to monitor claim volumes, identify trends, and drive continuous improvements in accuracy and turnaround times.
• Collaborate with IT and data teams to build dashboards and reports (e.g., in Power BI or Looker) that provide real-time visibility into key performance indicators.
• Partner with cross-functional teams (e.g., utilization management, configuration, compliance) to resolve complex claim issues and support strategic initiatives.
• Stay current on healthcare regulations, payer policies, and industry best practices to ensure ongoing compliance and competitive advantage.
• Serves as a key point of contact for audits, network management support, provider support teams, and member services leadership.
• Adheres to the rules and regulations of Curative as described in the Employee Handbook and as defined in the unit/department/clinic procedures.
• Performs all duties while maintaining compliance and promoting the mission of the organization.
• Performs other duties and projects assigned.
  
  

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• Ability to effectively communicate clearly and effectively with all levels of staff.
• Demonstrated ability to coach employees and teams for performance
• Demonstrated ability to consistently meet claim processing timeliness and quality metrics
• Knowledge of state prompt payment regulations and requirements for claims processing
• Knowledge of HIPPA regulations
• Knowledge of medical terminology, IDC-10 CPT, and HCPCS coding preferred
• Proficient computer skills to include Google-based applications (Docs, Sheets, Slides, Forms, etc.).
• Talent management – Attract, retain, and develop top talent
• Ability to sit for extended periods of time at a computer workstation.
  
  

Preferred Skills

• Demonstrated expertise in data analytics, with proficiency in SQL and advanced Excel functions (pivot tables, Power Query).
• Proven experience to optimize data analysis, machine learning, artificial intelligence, and automation.
  
  

EDUCATION And/or EXPERIENCE

• Bachelor’s /Associate degree in Healthcare Administration, Business, Finance, or related field required.
• Master’s degree in Healthcare Management, Data Analytics, or MBA preferred
• 5 years of experience in health insurance claims administration, with at least 2 years in a leadership or supervisory role.
• Demonstrated proficiency to create and use inventory management plans, workforce planning models, and performance metrics to optimize claim processing efficiency.
• Demonstrated ability to leverage interactive dashboards and visualizations using Power BI, Looker, or similar tools.
• Strong problem-solving skills, with a track record of identifying inefficiencies and implementing scalable solutions.
• Excellent interpersonal and communication skills, capable of influencing stakeholders at all levels.
• Deep understanding of health insurance operations, payer contracts, and regulatory frameworks (HIPAA, CMS guidelines).
• Preferred: Experience working with Health Edge - Health Rules Payer system, a variety of claims payment systems, processing of all claim types, to include hospital/facility, behavioral health, and professional medical claims.
  
  

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; talk; and hear.
• The employee may regularly be required to lift and/or move up to: 10 lbs., carrying small objects
• For this position the percentage of expected Travel is: 15 % of the time