Job Description
📋 Description Lead daily claims processing for timely, accurate adjudication. Develop end-to-end claims processes (adjudication, pend, payment). Optimize inventory management with KPI reporting. Manage complex/high-dollar claims and escalations. Analyze claims data to report metrics and risks. Drive process improvements and ensure regulatory compliance. 🎯 Requirements Bachelor's Degree or equivalent experience Subject matter expertise in medical claims and end-to-end processes 5+ years in claims, including team leadership Strong understanding of self- and level-funded health plans Strong problem-solving skills Commitment to outstanding member experiences Excellent communication and collaboration skills Extra credit: startup experience and Javelina claims system 🎁 Benefits Alternative medicine coverage Flexible PTO Up to 16 weeks paid parental leave Paid holidays 401k program Education reimbursement
