Claims Operations Manager Full Time NEW

Description

The Claims Operations Manager is responsible for overseeing the end-to-end claims processing function within a healthcare payer environment. This role ensures accurate, timely adjudication of claims, drives process improvements, and manages vendor relationships to optimize operational efficiency and service quality. The ideal candidate brings strong knowledge of healthcare claims workflows, a continuous improvement mindset, and experience working in fast-paced operations environments.

Claims Operations & Oversight

• Manage daily claims operations, including intake, adjudication, adjustments, and issue resolution
• Ensure claims are processed accurately, efficiently, and in compliance with regulatory and internal guidelines
• Monitor key performance indicators (KPIs) such as turnaround time, accuracy, and backlog

Process Improvement & Optimization

• Identify inefficiencies and implement process improvements to enhance productivity, quality, and cost-effectiveness
• Partner with internal stakeholders to streamline workflows and reduce manual intervention
• Support automation, system enhancements, and operational transformation initiatives

Vendor Management

• Oversee third-party vendors and business partners supporting claims processing
• Track vendor performance against SLAs and KPIs
• Collaborate with vendors to resolve escalations and improve service delivery

Team Leadership (Preferred)

• Provide guidance, coaching, and support to claims staff (if applicable)
• Foster a high-performance, collaborative team environment
• Support workforce planning, training, and talent development initiatives

Cross-Functional Collaboration

• Work closely with Provider Relations, Customer Service, Compliance, and IT teams
• Assist in resolving complex claims issues and escalations
• Participate in audits, compliance reviews, and reporting activities

Qualifications

• Experience in healthcare claims operations within a payer organization
• Strong understanding of claims processing workflows and adjudication concepts
• Knowledge of healthcare regulations, coding basics (ICD, CPT, HCPCS), and reimbursement methodologies
• Demonstrated ability to analyze processes and implement improvements
• Experience managing operational metrics and performance targets

Preferred

• Prior supervisory or team leadership experience
• Hands-on experience with claims adjudication systems (e.g., QNXT, Facets, or similar platforms)
• Experience working with third-party vendors or outsourced operations
• Lean, Six Sigma, or process improvement certifications (a plus)

Skills & Competencies

• Strong analytical and problem-solving skills
• Excellent communication and stakeholder management abilities
• Ability to manage multiple priorities in a fast-paced environment
• Detail-oriented with a focus on accuracy and quality
• Results-driven with a continuous improvement mindset

Skills

healthcare claims, healthcare operations, internal operations, claims process, claims management, claims resolution, claims adjudication, medical billing & coding, claim processing, provider claims, qnxt, facets

Top Skills Details

healthcare claims,healthcare operations,internal operations,claims process,claims management,claims resolution,claims adjudication,medical billing & coding,claim processing

Additional Skills & Qualifications

Previous experience working/managing offshore teams and familiarity with claims adjudication systems (QNXT, Facets, Epic Tapestry, HealthEdge, etc.,)

Experience Level

Intermediate Level

Job Type & Location

This is a Contract position based out of Honolulu, HI.

Pay And Benefits

The pay range for this position is $30.00 – $32.00/hr.

Requirements

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a hybrid position in Honolulu,HI.

Application Deadline

This position is anticipated to close on May 30, 2026.

About TEKsystems

We’re partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That’s the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems And TEKsystems Global Services

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.