Head of Claims & Insurance Operations

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start‑up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process‑as‑a‑service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth.

UST HealthProof is looking for a Manager I, Claim Operations. The Claims Operations Manager I is responsible to develop and maintain metrics/reports/tools to support various claim initiatives and personnel. The Manager will provide execution and strategic expertise to support day to day inventory and claims initiatives’ success. The Manager will service as an integral part of the leadership team to help strategically plan for growth and develop ways to increase optimal operational efficiencies and quality of claims processing. As a Manager, Claims Operations at UST HealthProof, this is your opportunity to

Assess and manage claims inventory; track and manage inventory trends and proactively adjusts resource levers as needed to maximize productivity to meet inventory management goals

analyze data, proactively assesses business needs

Apply subject matter expertise to the business of claims processing and operations

Manage and coach individual contributor performance and quality using quantitative and qualitative data

Train and coach staff and vendors on claims processes

Use knowledge of CMS and regulatory claims processing guidelines to drive compliance in HealthProof claims processing policies and procedures

Work with Business Analysts and Technical Writers to design and document workflows and business processes

Recommend strategies for attaining and exceeding claims operations SLAs

Recommend training assets and job aids to improve operational effectiveness

A minimum of 7 years of health insurance claims experience with progressive leadership responsibilities

An ability to independently direct the implementation of complex business projects

Working knowledge of other functions within insurance operations and shared services (benefits, enrolment, compliance, medical management, customer service etc.)

Experience in MS Word, Excel, PowerPoint, MS Visio

An operating knowledge of Lean Six Sigma and or AGILE, preferred

Geographic Responsibility: Remote, US

Type of Employment: Full‑time, permanent

The employee is occasionally required to move around the office. Work across multiple time zones in a hybrid or remote work environment.

Long periods of time sitting and/or standing in front of a computer using video technology.

May require travel dependent on company needs.

In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.

J-18808-Ljbffr HealthEdge Software, Inc.