What are the responsibilities and job description for the Manager, Claims Operations position at Storm3?
đź“Ť On-site, 5 days/week (Greenwhich, CT)
đź’° Base Salary: $145K-170K Base; Bonus
đź’Ľ Department: Operations
About the Role
We’re seeking an experienced Manager of Claims Operations to lead the end-to-end claims function and drive operational excellence across a fast-growing healthcare organization. This role is hands-on, highly visible, and central to improving accuracy, timeliness, efficiency, and the overall member and provider experience.
You’ll partner closely with leadership, IT, and cross-functional teams to streamline workflows, oversee adjudication, ensure compliance, and deliver high-quality outcomes at scale.
What You’ll Do
- Lead and manage all daily claims operations, including claim evaluation, adjudication, resolution, and escalations.
- Oversee intake, processing, customer service, and compliance to meet contractual and regulatory standards.
- Coach, develop, and supervise claims team members; ensure performance meets productivity and quality targets.
- Monitor work queues, assign tasks, and prioritize workloads for timely turnaround.
- Conduct regular audits to ensure accuracy, completeness, and adherence to policies and procedures.
- Identify workflow gaps and implement process improvements to enhance efficiency and reduce errors.
- Partner with IT to refine claim systems, EDI processes, and automation tools.
- Prepare and present performance reports, highlighting trends, variances, and operational insights.
- Support new client onboarding and implementation efforts as needed.
- Uphold HIPAA compliance and data privacy standards.
Who You Are
- Bachelor’s degree in Business or related field (or equivalent experience).
- 7 years of experience supervising and developing teams in a healthcare payer, delegated vendor, or TPA environment.
- Expert understanding of claims adjudication, eligibility, benefit determinations, and payer interfaces.
- Strong familiarity with EDI submissions, EFT payments, and provider/member web portal workflows.
- Knowledge of health insurance products (HMO, PPO, EPO, HDHP, HSA/HRA, copay/coinsurance structures).
- Strong analytical skills and ability to track performance metrics and recommend improvements.
- Comfortable collaborating with IT and using technology to optimize operations.
- Proficiency in MS Excel and knowledge of ICD-10, CPT/HCPCS, and NDC/GPI coding.
- Excellent communication, leadership, problem-solving, and customer service skills.
What We Offer
- Competitive base salary ($145K-170K), Bonus
- Clear path for advancement (potential for Senior Manager/Director track)
- Collaborative environment with leadership visibility
- Opportunity to modernize and scale claims operations within a growing organization
Salary : $145,000 - $170,000