Claims Manager

Role Description

tango is currently looking for a Claims Manager to join our growing team!

The Claims Manager provides tactical, technical leadership for claims operations with a focus on issue resolution, process improvement, auditing, and cross-functional support. This role is specialized in technical troubleshooting, claims reconciliation, batch processing, and collaboration with internal partners to ensure the smooth operation of claims workflows.

Office Location: 2415 E Camelback Road, Suite 700, Phoenix, AZ 85016

Remote

Responsibilities and Duties

• Serve as technical lead for problem-solving claims issues; troubleshoot and resolve issues during operational disruptions.
• Oversee batch assignments, batch-closure operations, adjudication runs and claims reconciliation processes.
• Execute audit and universe review protocols; ensure data integrity and accuracy across all claims transactions.
• Oversee the 277CA process.
• Oversee performance of systemic tools (Symkey, AMP$, EDIWORKS, SDS or other applicable tools) to ensure transparency, capability alignment, and long-term sustainability, enabling the team to operate efficiently and effectively.
• Ensure SFTP process reliability for claims file transfers; monitor all inbound and outbound jobs and alert to transmission failures.
• Manage and remediate clearinghouse rejections; coordinate correction cycles with vendors and internal teams.
• Collaborate with QA and team members to identify, test, and implement new business rules to improve adjudication rates and minimize claim errors.
• Partner with Provider Contracting, Networks, and Accounting teams to resolve fee schedule, network setup, and payment processing issues.
• Collaborate with Eligibility and Authorization teams to resolve member-related issues impacting claims processing.
• Maintain comprehensive documentation of all processes, issue resolutions, and system updates.
• Recommend and implement process improvements based on operational analysis and performance metrics.

Qualifications

• Bachelor's degree or equivalent technical experience.
• 5+ years in healthcare claims operations, with expertise in workflow optimization and technical troubleshooting.
• Strong knowledge of claims adjudication, batch processing, EDI/clearinghouse operations, and accounting reconciliation.
• Advanced understanding of SFTP/file transfer protocols and claims system architecture.
• Proficiency with claims platforms, data analysis, and SQL or similar query tools preferred.
• Excellent analytical, organizational, and cross-functional communication skills.
• Ability to manage multiple complex issues and prioritize effectively in a fast-paced environment.

Requirements

• Technical problem-solver with strong analytical and troubleshooting capabilities.
• Proactive and detail-oriented with commitment to accuracy and process integrity.
• Strong collaboration skills with ability to partner across departments and teams.
• Initiative-driven with focus on continuous improvement and operational efficiency.
• Reliable and accountable with strong work ethic and deadline commitment.
• Self-motivated learner with ability to stay current on system and regulatory changes.
• Composed and professional under pressure with strong decision-making abilities.

Company Description

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.