Claims Operations Manager

About Our Client:Zing Health operates in the Medicare Advantage insurance sector, focusing on improving healthcare for individuals aged 65 and older. The organization addresses challenges related to social determinants of health by centering care around both physicians and members. It provides personalized plan options, accessible facilities, and dedicated care teams to support members' healthcare needs. About the Opportunity:The CLAIMS OPERATIONS MANAGER leads the implementation and ongoing management of Medicare claims operations within the program. This role ensures compliance with Centers for Medicare & Medicaid Services (CMS) regulations and supports delegated Medicare Advantage functions. The manager drives operational accuracy, policy development, and effective collaboration across departments to uphold quality and regulatory standards. Responsibilities:Oversee claims production and vendor management for Medicare Advantage linesDevelop and enhance internal controls, policies, and proceduresMaintain current knowledge of government regulations affecting claims processingInvestigate and respond to claims inquiries from members, providers, and agenciesEnsure quality control and analyze root causes of payment variationsSupport high provider satisfaction through timely dispute and appeal handlingCollaborate with technical teams and vendors to maintain compliant claims systemsCoordinate electronic data interchange for claims submissions and processingMonitor claims accuracy and identify trends to reduce disputesSupervise staff performance, provide training and feedback, and address disciplinary needsWork cross-functionally to resolve operational issues and escalate as neededProvide guidance to ensure compliance with Medicare Advantage contracts and CMS rulesDeliver accurate reporting and participate in audits and compliance reviewsContribute to development and implementation of new programs and strategic plansSupport corrective action plans and quality improvement efforts through audits Requirements:Minimum four years in a management roleAt least four years of Medicare claims experience; experience with Medicare/DSNP/ACA Exchange operations preferredSeven years of health plan administration experience Pay Range and Compensation Package:The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors. Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.