Assistant Manager for the Operations Control Room ensuring compliance and leading real - time operating personnel. Supervise daily operations and mentor staff in a dynamic environment.
About the role
- Claims Operations Manager building operational functions for a digital claims and rebate platform. Leading daily validation processes and driving automation in partnership with engineering.
Responsibilities
- Hire, onboard, and manage a small team of Operations Analysts: building workflows, SOPs, escalation paths, and QA frameworks from a blank slate.
- Own end-to-end claim validation: daily intake, review, approval, denial, and reconciliation, including hands-on management of the Manual Review Queue for claims flagged by logic deviations, data quality issues, or edge cases.
- Partner with Engineering and Product to translate operational workflows into system requirements and drive the transition from manual processing to scalable automation.
- Serve as the operational point of contact for veterinary clinics and pharmaceutical manufacturer stakeholders by handling escalations, guiding denial remediation, and reporting on claims trends and program performance.
- Define and own operational KPIs such as turnaround time, approval/denial rates, accuracy, backlog volume, and build recurring reports, SLAs, and benchmarks for internal leadership and external partners.
Requirements
- Bachelor's degree in Business Administration, Information Technology, Computer Science, or a related field.
- 5+ years in claims processing, payment reconciliation, or operations (healthcare, insurance, fintech, or SaaS).
- 3+ years of people management, which includes hiring, coaching, and performance accountability.
- Strong grasp of claims adjudication, approval/denial workflows, exception handling, and remediation processes.
- Experience with Jira Service Management (JSM) for queue management, claims workflows, and SLA tracking.
- Proven ability to build operational processes from scratch, including SOPs, SLAs, queue management, escalation paths, and QA with no existing playbook.
- Cross-functional experience working with engineering/product teams to translate ops needs into system requirements.
- Excellent written and verbal communication across technical and non-technical stakeholders.
- Serve as a professional point of contact for veterinary clinics and pharmaceutical partners, clearly communicating claim decisions, resolving inquiries, and ensuring a positive and trusted customer experience.
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