Sr. Manager of Healthcare Claims - TPA

For our client, we are seeking a Sr. Manager of Healthcare Claims - TPA to join the team of a leader in the Information Technology space. This role will lead healthcare claims operations with a strong focus on timely, accurate adjudication, compliance, and process discipline. The Sr. Manager will guide a team of examiners, resolve complex escalations, and partner cross-functionally to improve systems, workflows, and service outcomes. This position also plays a key role in managing audit readiness, regulatory response, and KPI-driven operational improvement within a third-party administrator environment. Location: Remote - US based candidates only, no visa sponsorship available Compensation: $107,000 – $140,000 annually Responsibilities Lead and develop a claims team by coaching and holding accountable a team of examiners Oversee resolution of complex high-risk claims to ensure timely and accurate adjudication Resolve escalated issues and payment discrepancies in high-stakes situations Coordinate responses to audits and regulatory inquiries, ensuring documentation is thorough Drive compliance with Medicare, HIPAA, and regulatory standards through ongoing reviews Identify operational inefficiencies and implement best practices Collaborate with cross-functional teams to enhance system and process efficiencies Monitor KPIs to derive actionable insights and make clear recommendations Qualifications Bachelor's degree in Business Administration, Health Administration, or related field preferred 7+ years of experience in claims operations, ideally in a TPA environment 5+ years of leadership or supervisory experience in claims management Deep knowledge of claims processing systems and regulatory requirements (Medicare, HIPAA, DOL) Proficiency in KPI analysis and process improvement methodologies Benefits Competitive base salary and benefits effective day one Comprehensive medical and dental coverage through the company's health solutions Unlimited PTO to ensure sufficient rest and recharge Mental health support along with retirement planning and financial protection Opportunities for professional development and clear career progression Mission-driven culture that values diverse perspectives and real impact on health Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.