medical claims manager

Imagenet, LLC

<div>Claims Adjudication Manager

U.S.-Based Operational Leader Overseeing Philippines Claims Adjudication 
Work Setup: Remote

Reports To: SVP Operations

Direct Oversight: Philippines-based claims adjudication team (examiners, auditors, team leads)

Hours: Pacific Time Zone: Core overlap with Philippines business hours required; evening calls for client/offshore alignment 
Role Summary

Imagenet is seeking an experienced, U.S.-based Claims Adjudication Manager to provide hands-on operational leadership for a claims adjudication account, which is delivered through our wholly owned global delivery center in the Philippines. This is a player-coach role for a seasoned claims subject-matter expert (SME) who can bridge U.S. client expectations and offshore delivery &mdash; directly strengthening quality, throughput, reporting accuracy, and client-facing credibility. 
The successful candidate combines deep adjudication expertise in both hospital (facility) and professional claims with proven experience leading and developing offshore claims teams. They will serve as the senior operational point of contact for the client, set the standard for adjudication accuracy, and build the coaching, audit, and documentation infrastructure needed to deliver consistent, high-quality outcomes at scale. They will not hesitate to role up their sleeves and dive into production and quality. 
Key Responsibilities

Operational Leadership (Onshore Lead for Offshore Delivery)
<ul>
<li>Provide day-to-day operational leadership for the Philippines-based adjudication team (examiners, auditors, and team leads), working across time zones to direct priorities and remove blockers.</li>
<li>Serve as the hands-on claims SME for the campaign &mdash; personally adjudicating complex or escalated claims and modeling correct handling for the team.</li>
<li>Drive accuracy, productivity, quality, and service-level goals; translate client requirements into clear, executable operating procedures.</li>
<li>Partner with the offshore manager and team leads to strengthen communication, information flow, and consistency of execution.</li>
</ul>
Client Engagement &amp; Single Point of Contact
<ul>
<li>Act as the senior operational single point of contact (SPOC) for the client, consolidating guidance from multiple client stakeholders into one consistent set of directives for the delivery team.</li>
<li>Lead client working sessions, escalations, and operational updates with confidence and credibility; provide clear written and verbal updates on performance, quality, and improvement actions.</li>
<li>Manage frequently changing client requirements &mdash; capturing, sequencing, and operationalizing new directives without disrupting production.</li>
</ul>
Quality, Coaching &amp; Audit
<ul>
<li>Own the quality program: reduce repeat errors, identify root causes, and close coaching gaps through targeted, SME-led feedback.</li>
<li>Align coaching responsibilities with subject-matter expertise; design and lead calibration sessions between examiners and auditors.</li>
<li>Assess auditor capability and set audit-throughput targets that balance thoroughness with release timelines.</li>
</ul>
Reporting &amp; Production Validation
<ul>
<li>Oversee validation of production reporting; partner with the business analyst and client to resolve reporting discrepancies (e.g., over- or under-counting) and establish a trusted tracking methodology.</li>
<li>Use data to identify capacity, monitor service levels, and demonstrate measurable improvement to the client.</li>
</ul>
Documentation &amp; Knowledge Management
<ul>
<li>Establish and maintain a centralized documentation and knowledge-management process for client directives, reducing reliance on individual knowledge.</li>
<li>Ensure source documentation is centralized and current so that AI-assisted retrieval and other enablement tools deliver reliable answers.</li>
</ul>
Workforce &amp; Cross-Functional Collaboration
<ul>
<li>Partner with HR and recruiting to accelerate hiring, rebuild the candidate pipeline, and stabilize staffing levels.</li>
<li>Collaborate with QA, training, workforce management, infrastructure/IT (including connectivity and latency monitoring for remote staff), and client services to support execution.</li>
<li>Coordinate with consultants, business analysts, and transition partners during onboarding and ramp activities.</li></ul> 


Must-Have Qualifications
<ul>
<li>6+ years of U.S. healthcare claims adjudication experience, with hands-on expertise in BOTH hospital/facility (UB-04) and professional (CMS-1500/HCFA) claims.</li>
<li>3+ years leading claims teams (managing 30&ndash;40+ examiners/auditors, directly or through team leads), ideally including offshore or BPO/shared-services teams.</li>
<li>Demonstrated ability to serve as a client-facing operational leader &mdash; running working sessions, owning escalations, and building client trust.</li>
<li>Strong command of claims workflows, medical terminology, coding concepts, benefits, and payer/provider processes.</li>
<li>Proven track record managing productivity, quality, service levels, and team performance in a metrics-driven environment.</li>
<li>Experience coaching examiners and reducing error rates through structured quality and calibration programs.</li>
<li>Excellent written and verbal communication; able to work effectively across cultures and time zones.</li>
<li>Strong analytical and problem-solving skills, including working with production and quality data.</li></ul> 


Preferred Qualifications
<ul>
<li>Experience overseeing or supporting Philippines-based or other offshore healthcare claims operations.</li>
<li>Experience supporting U.S. health plans, TPAs, healthcare BPOs, or shared-services operations.</li>
<li>Exposure to payment review, denials, appeals, or related claims functions.</li>
<li>Experience building documentation/SOP libraries and knowledge-management processes.</li>
<li>Exposure to process improvement, automation, or digital-transformation initiatives (including AI-assisted enablement tools).</li>
<li>Familiarity with claims platforms and reporting validation.</li></ul> 


Key Competencies
<ul>
<li>Hands-on claims adjudication expertise (hospital + professional)</li>
<li>Operational leadership of distributed / offshore teams</li>
<li>Client and stakeholder communication; single point of contact</li>
<li>Quality, coaching, and audit calibration</li>
<li>Analytical thinking, reporting validation, and problem-solving</li>
<li>Continuous improvement and cross-functional collaboration</li></ul> 


Company Overview

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services &mdash; including digital transformation, claims adjudication, and member and provider engagement services &mdash; acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with their members and providers. 
The company currently serves over 70 health plans, processing millions of claims and the related structured and unstructured data elements within those claims annually. Imagenet has also developed an innovative workflow technology platform, JetStream&trade;, to support traceability, governance, and automation of claims operations for its clients. 
Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S., and has a wholly owned global delivery center in the Philippines.</div>

Claims Adjudication Manager

Walmart

<div><h2 class="jobSectionHeader">Position Summary...</h2><h2 class="jobSectionHeader">
What you'll do...</h2>
Role summary:
 
The Manager, Claims Management oversees the evaluation and resolution of claim disputes, ensuring accuracy and compliance with regulatory and company standards. This role leads quality assurance initiatives to enhance claims handling processes and manages relationships with internal teams and external partners to drive continuous improvement. The position requires strategic oversight of billing procedures, risk mitigation, and legal exposure while fostering a high-performing team through effective supervision and development. The manager champions integrity, operational excellence, and collaboration to support business objectives and deliver consistent, efficient claims management outcomes.
 
About the team:
 
The Walmart Claims Services team leads the management and resolution of claims through thorough investigations, audits, and quality assurance processes. This team ensures compliance with industry standards and regulatory requirements while minimizing financial and legal risks. Collaborating with internal and external partners, they enhance claims handling efficiency and accuracy. Committed to continuous improvement, the team supports professional growth and fosters accountability and integrity. Their efforts contribute to delivering consistent, high-quality service aligned with Walmart&rsquo;s mission and values, driving operational excellence and risk management across the organization.
 
What you'll do:
 
<ul><li>Supervise claim disputes by reviewing files, coordinating with experts, and determining claim validity to ensure accurate settlement or denial.</li><li>
Manage quality assurance audits to enhance claims handling consistency, compliance, and communication with customers.</li><li>
Oversee third-party billing procedures, ensuring alignment with regulatory and industry standards to reduce financial risk.</li><li>
Minimize legal exposure by collaborating with outside counsel, participating in arbitrations, and structuring complex settlements.</li><li>
Drive continuous improvement by analyzing claims data, monitoring trends, and developing strategies to optimize claims management processes.</li><li>
Provide leadership through hiring, training, mentoring, and fostering accountability within the claims team.</li></ul>
 
What you'll bring:
 
<ul><li>Proven expertise in claims resolution, risk management, and claims processing within complex environments.</li><li>
Strong leadership skills with experience supervising and developing teams to achieve performance goals.</li><li>
Ability to conduct quality assurance audits and analyze trends to enhance claims handling procedures.</li><li>
Proficiency in managing compliance with third-party billing requirements and regulatory standards.</li><li>
Skilled in fostering collaborative relationships with internal and external partners to drive continuous improvement.</li><li>
Demonstrated adaptability and commitment to ethical practices aligned with company values.</li><li>
Experience leveraging data analytics to inform strategic decisions and optimize claims management processes.</li></ul>
At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more. You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable. For information about PTO, see https://one.walmart.com/notices. Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.
 
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 a specific plan or program terms.
 
For information about benefits and eligibility, see One.Walmart.
 
The annual salary range for this position is $80,000.00 - $155,000.00 Additional compensation includes annual or quarterly performance bonuses. Additional compensation for certain positions may also include :
 
<ul><li>Stock</li></ul>
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&lrm;<h2 class="jobSectionHeader">
Minimum Qualifications...</h2>
Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Minimum Qualifications: Bachelor's degree and 2 years&rsquo; experience in insurance claims or relevant area OR 4 years&rsquo; experience in insurance claims or related area<h2 class="jobSectionHeader">
Preferred Qualifications...</h2>
Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.
Customer Service, Supervising Associates<h2 class="jobSectionHeader">
Primary Location...</h2>
905 Customer Dr, Bentonville, AR 72716, United States of America
Walmart and its subsidiaries are committed to maintaining a drug-free workplace and has a no tolerance policy regarding the use of illegal drugs and alcohol on the job. This policy applies to all employees and aims to create a safe and productive work environment.</div>

(USA) Manager, Claims Management

King County, WA

<div>JOB

King County's Office of Risk Management Services is seeking an exceptional people leader to become our new Claims Manager. This person will manage a team of Claims Investigators who are responsible for providing coordination of all tort claims made against King County and its officials, officers and employees.
This position functions with a considerable degree of independence and judgment, and interfaces with the County&rsquo;s attorneys, and departmental management and staff. The position requires a working knowledge of the principles of risk management as they relate to public entity exposures, commercial insurance, and loss control.
ABOUT THE OFFICE OF RISK MANAGEMENT SERVICES 
The Office of Risk Management Services provides external services to the community as well as internal services to King County agencies, including:<ul><li>
Claims: King County investigates, evaluates, and resolves claims made against the county in a fair and expeditious manner.</li><li>
Insurance: King County administers a self-insurance program and purchases a variety of other insurance policies and related services consistent with sound risk management practices and the needs of the County.</li><li>
Contracts: Risk Management advises King County agencies on insurance requirements in all types of contracts. Risk Management actively negotiates and, together with the Prosecuting Attorney's Office, assists agencies in pursuing and tendering claims arising out of contractual relations.</li><li>
Recovery Services: Risk Management is charged with seeking compensation for damages caused to King County property or injury to King County employees by negligent third parties.</li><li>
Enterprise Risk Management Program (ERM): ERM works to proactively identify and assess high priority risks King County owns and improve controls for those risks. The program provides King County departments with consultation, data, and direct support to improve decision making and action planning.</li><li>
Finance &amp; Administration: provides a wide range of financial and administrative support services to the division including budget, accounting, and general office support.</li><li>
Open Government: Seeks to deliver government transparency, accountability, and accessibility through administration of the Public Records (Disclosure) Program, Ethics Program, Financial Disclosure Program, and Lobbyist Disclosure Program.</li></ul> 
EXAMPLE OF DUTIES

SCOPE OF JOB DUTIES: In order to be considered for this opportunity, you must at a minimum, demonstrate skill and ability to:<ul><li>
Review, evaluate and monitor claims made against the County.</li><li>
Plan and coordinate investigative activities on claims with claims officers and King County Prosecuting Attorney&rsquo;s Office.</li><li>
Advise County officials, officers, employees, agents and managers on financially serious or sensitive matters.</li><li>
Review and evaluate all file materials and recommendations prepared by Claims Officers for accuracy and thoroughness in making final disposition on claim.</li><li>
Represent the County at mediations, settlement conferences, arbitrations and briefings to King County Executive on claims settlements.</li><li>
Make policy decisions and recommendations on office operations and procedures.</li><li>
Identify and coordinate loss control projects with the Enterprise Risk Manager and claims officers.</li><li>
Look for efficiencies and identify areas for improvement of service.</li><li>
Serves as a member of the ORMS Management Team.</li><li>
Supervise the work of team members. Hire, assign and schedule work, evaluate performance, train, coach and initiate disciplinary action when appropriate.</li></ul>
SUPPLEMENTAL INFORMATION
 
<ul><li>This position is exempt from the Fair Labor Standards Act.</li><li>
This position is not represented by a union.</li></ul>
Why King County?<ul><li>
Competitive &ndash; healthcare plans</li><li>
Free &ndash; transportation options</li><li>
Manager Support &ndash; structured employee assistance program</li><li>
Paid &ndash; vacation time (in addition to paid holidays)</li><li>
Paid &ndash; sick leave</li><li>
Deferred &ndash; compensation plan</li><li>
Twelve &ndash; paid holidays</li><li>
Awesome - Employee Giving Program</li></ul>
Forbes named King County as one of Washington State's best employers.
Together, with leadership and our employees, we're changing the way government delivers service and winning national recognition as a model of excellence. Are you ready to make a difference? Come join the team dedicated to serving one of the nation's best places to live, work and play. Guided by our &quot;True North&quot;, we are making King County a welcoming community where every person can thrive. We value diversity, inclusion and belonging in our workplace and workforce. To reach this goal we are committed to workforce equity. Equitable recruiting, support, and retention is how we will obtain the highest quality workforce in our region; a workforce that shares and will help advance our guiding principles - we are one team; we solve problems; we focus on the customer; we drive for results; we are racially just; we respect all people; we lead the way; and we are responsible stewards. We encourage people of all backgrounds and identities to apply, including Native American and people of color, immigrants, refugees, women, LGBTQ+, people living with disabilities, and veterans.
King County is an Equal Employment Opportunity (EEO) Employer
No person is unlawfully excluded from employment opportunities based on race, color, religion, national origin, sex (including gender identity, sexual orientation and pregnancy), age, genetic information, disability, veteran status, or other protected class. Our EEO policy applies to all employment actions, including but not limited to recruitment, hiring, selection for training, promotion, transfer, demotion, layoff, termination, rates of pay or other forms of compensation.
Are you ready to APPLY?
The recruitment for this position is open to all qualified applicants. A completed King County Application is required. We highly recommend that you also provide a cover letter and resume. If you have any questions, please contact Jen Irwin, Talent Management Supervisor, by e-mail at jirwin@kingcounty.gov, or by phone at 206-263-0601. Connect with Jen on LinkedIn.</div>

Claims Manager

Air Evac Lifeteam

<div>Job Description:

Revenue Cycle Medical Billing Manager -
Payor Verification / Claim Filing - Government Claims
Location: Remote or On-Site (West Plains, MO)
Annual Compensation: $68,000
Schedule: Full-Time 
JOB SUMMARY:
The Manager of the Pre-Bill (Payor Verification / Claim Prep &amp; File) for Government claims, serves as a cornerstone in the Revenue Cycle team, steering members toward consistent levels of quality, efficiency, and productivity to ensure all departmental goals are met. Through active mentorship, they provide employees with clear guidance, motivation, and a sense of purpose, all of which are essential in advancing the department&rsquo;s mission and driving collective success. By directly overseeing revenue continuity and streamlining key processes, this manager not only ensures financial stability but also fosters a positive, collaborative workplace culture. 
ESSENTIAL FUNCTIONS/DUTIES:<ul><li>
Implement, manage, and provide oversight to develop processes that result in a consistent and predictable cash flow.</li><li>
Maintain a working knowledge of government billing regulations (including but not limited to CMS).</li><li>
Ensure billing compliance and claim integrity with timely payor verification and claims submission.</li><li>
Mentor and grow leadership and staff.</li><li>
Set and manage goals that foster and motivate high performing teams.</li><li>
Maintain effective collaboration with both Pre-Bill and Post-Bill teams that support first file claim cleans.</li><li>
Responsible for teams&rsquo; timely submission of Sarbanes Oxley required documentation.</li><li>
Gather, analyze, and identify billing problems recommending corrective actions and procedural changes.</li><li>
Budgetary responsibilities as assigned and in accordance with company policy, acting with responsibility on behalf of the company.</li><li>
Prepare relevant materials and data before meetings.</li><li>
Seek opportunities for innovation and process improvement through new ideas with automation and technology, etc.</li></ul>
SKILLS:<ul><li>
Ability to prepare and lead presentations when needed</li><li>
Skilled in collaboration within all levels of the organization</li><li>
Ability to work effectively as a member of a leadership team</li><li>
Strong problem-solving skills through critical thinking, attention to detail, and ability to make timely decisions</li><li>
Ability to set priorities and manage time effectively</li><li>
Ability to communicate professionally and clearly, both verbally and in writing</li><li>
Demonstrate understanding of CMS, HIPAA, and other payor rules and regulations as well as GMR policies</li><li>
Knowledge and understanding of payor Explanation of Benefits (EOB)</li><li>
Ability to drive results, review/improve processes, and manage change</li><li>
Display excellent internal and external customer service skills</li><li>
Ability to work with large volumes of data including knowledge of pivot tables and other Excel functions</li></ul> 
 REQUIRED EXPERIENCE:<ul><li>
Minimum five (5) years of medical billing experience</li><li>
Minimum of 2 years full-time experience in managerial or supervisory position with direct Revenue Cycle responsibility</li><li>
Must be fluent in English</li><li>
Ability to work independently or as an active member of a team</li><li>
Knowledge and experience of computers and related technology, at an advanced level</li></ul> 
PREFERRED EXPERIENCE:<ul><li>
Above average knowledge of CMS and all Government payor billing guidelines</li><li>
Knowledge of the Federal No Surprises Act/ Independent Dispute Resolution (IDR)</li></ul> 
EDUCATION:<ul><li>
Bachelor&rsquo;s degree in business, healthcare administration or equivalent and/or relevant work experience may substitute for degree requirements.</li></ul> 
Why Choose Air Evac Lifeteam? As a leader in helicopter air ambulance services, Air Evac Lifeteam is one of Global Medical Response&rsquo;s (GMR) family of solutions. Our GMR teams deliver compassionate, quality medical care, primarily in the areas of emergency and patient relocation services. View the stories on how our employees provide care to the world at www.AtaMomentsNotice.com. 
GMR&rsquo;s Core Behaviors&mdash;keep care at the center, raise your hand, seek to understand, find a way together and be accountable&mdash;unite our teams and set us apart in emergency medical services.
EEO Statement:

Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing reasonable accommodations for individuals with a disability.
More Information about this Job:
<div>
Check out our careers site benefits page to learn more about our benefit options.</div></div>

Revenue Cycle Medical Billing Manager - Payor Verification / Claim Filing - Government Claims

H.J. Martin and Son

<div>Department: Residential
Hours: Full-time Monday through Friday (8:00 a.m. to 5:00 p.m.) 
Thank you for considering employment with H.J. Martin and Son! 
Please complete all sections of the application to the best of your ability. Once submitted, your application will be reviewed by our hiring team, and we will contact you if your skills and experience align with our current openings. 
Company Description: H.J. Martin and Son is a specialty contractor with services in residential &amp; commercial flooring, commercial glass, walls &amp; ceilings, doors, hardware &amp; specialties, and millwork &amp; FF&amp;E, along with national retail solutions, including fixture installation. Founded in 1931, the fourth-generation company works nationwide from its headquarters in Green Bay, WI.</div>
 <div>Position Description: The Claims Manager works closely with customers, manufacturers , and internal teams to investigate claims, resolve issues efficiently, and maintain compliance with company policies and industry standards.
Principal Responsibilities:
<ul><li>Scheduling appointments with homeowners, contractors and vendors to set up inspections</li>
<li>Meet with homeowners and contractors to inspect hard surface and soft surface flooring along with taking pictures of affected areas</li>
<li>Explaining the claims process to homeowners and contractors</li>
<li>Properly handling customer&rsquo;s complaints and concerns</li>
<li>Ensure a positive outcome for all customers</li>
<li>Labeling electronic folders and downloading pictures into these folders for future reference</li>
<li>Collecting pertinent information from RFMS, including orders, purchase orders, product information and roll numbers</li>
<li>Using collected information to file a claim with the appropriate vendor or mill, via internet, fax or phone</li>
<li>Figure material costs, amount of product needed, sundry amounts and the labor associated with the removal and new installation for each claim</li>
<li>Creating orders once material and installation costs have been figured</li>
<li>Ordering material and scheduling installs with installation department</li>
<li>Saving orders with line item amounts in electronic folders for future labor requests</li>
<li>Adding daily notes of interactions between yourself, vendors, mills, homeowners and contractors into the claim to track timelines and pertinent information</li>
<li>Conducting follow up calls or emails to mills, vendors or reps to check status on existing open claims</li>
<li>Keeping salesperson or designer informed and up to date with the status for each of their open claims</li>
<li>Creating an open claims list each week or when requested for AR</li>
<li>Tracking credit memos and payments for existing open claim to ensure reimbursement on all claims</li>
<li>Checking job costs in Timberline software</li>
<li>Adjust labor costs and enter into order prior to submitting labor requests from the mill or vendor</li>
<li>Close and bill out claim orders after satisfactory reimbursements have been received</li>
<li>Effectively create denial, settlement and approval letters</li>
</ul>Other Duties As Assigned: Performs other related duties as assigned including supporting team members in the completion of their work for the purpose of ensuring the efficient and effective functioning of the business.</div>
 <div>Experience/Education Required:
<ul><li><ul><li>Bachelor&rsquo;s degree is preferred, but not required
</li><li>Flooring experience is preferred, but not required</li>
<li>Proficient with Microsoft Office and Adobe Acrobat</li>
<li>Highly organized, and ability to handle multiple project/tasks simultaneously</li>
<li>Proven ability to effectively communicate and apply policies and procedures to others</li>
<li>Strong analytical skills</li>
</ul></li></ul>Conditions of Employment: Must be able to pass pre-employment background check and drug screen. The employee is expected to all adhere to all company policies.</div>
 <div>AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER</div>

OneAmerica Financial Partners, Inc

<div>At OneAmerica Financial, our purpose is to create more certainty for our customers that leads to better moments, every day. Our commitment is to advance stability and growth in every solution and relationship. We deliver financial strength that builds for generations, and we are always aspiring, looking ahead, and collaborating to achieve more, together. Come be a part of this journey with us as we champion lives!

The Supplemental Health Claims Manager is an individual contributor responsible for providing subject matter expertise to design, implement, and continuously improve supplemental health claims processes, procedures, and workflows. This role partners closely with Claims Operations, Product, Compliance, Training, and Technology teams to ensure customer-focused, compliant, and efficient claims practices. The position may also adjudicate claims and support quality initiatives as needed.

Key Responsibilities:
<ul>
<li>Process, procedure, and workflow design: Lead the development and implementation of new and revised supplemental health claims processes, standard operating procedures (SOPs), desk-level job aids, workflow diagrams, and controls to support consistent, scalable operations.</li>
<li>Technical claims subject matter expertise: Serve as the go-to expert for supplemental health products (Accident, Critical Illness, Hospital Indemnity, Wellness, etc.) and interpret plan provisions, definitions, limitations, exclusions, riders, and administrative rules to guide accurate claims outcomes.</li>
<li>Systems design and requirements support: Partner with Technology and business stakeholders to translate operational needs into clear requirements (rules, routing, templates, decision logic, edits, and reporting), validate design, and support testing (UAT) to ensure systems enable compliant and efficient claims processing.</li>
<li>Eligibility and efficiency optimization: Identify opportunities to improve eligibility verification, evidence collection, and straight-through processing; recommend automation and controls to reduce rework, turnaround time, and preventable denials while maintaining accuracy and customer experience.</li>
<li>Training and knowledge enablement: Contribute to training program development by creating curriculum content, job aids, and scenario-based learning; deliver or support training for new hires and tenured staff on product knowledge, systems, and procedure changes.</li>
<li>Continuous improvement and quality: Analyze operational performance (e.g., turnaround time, accuracy, denial drivers, customer contacts), support root-cause investigations, and implement corrective actions; participate in audits and quality reviews to sustain high standards.</li>
<li>Regulatory compliance and industry awareness: Stay current on applicable federal/state regulations, market trends, and internal compliance requirements; assess impacts to claims handling and proactively recommend updates to procedures, controls, training, and communications.</li>
<li>Claims adjudication (as assigned): Review and adjudicate supplemental health claims in accordance with plan provisions and procedures</li>
</ul>
Required Qualifications
<ul>
<li>Bachelor&rsquo;s degree (or equivalent combination of education and related experience).</li>
<li>3+ years of experience in supplemental health (voluntary benefits) claims operations and/or claims adjudication (Accident, Critical Illness, Hospital Indemnity, Wellness, etc.).</li>
<li>Experience with process improvement methods, service-level management, and quality/audit programs.</li>
<li>Experience creating and maintaining operational documentation (SOPs, workflows, job aids) and communicating process changes to stakeholders.</li>
<li>Experience supporting implementations or migrations of claims platforms (requirements, configuration support, testing, training, go-live readiness).</li>
<li>Demonstrated training facilitation experience (live sessions, virtual training, train-the-trainer).</li>
<li>Demonstrated ability to interpret plan provisions/contract language and apply it consistently to claim scenarios.</li>
<li>Working knowledge of claims systems and operational controls (queue routing, decision rules, correspondence templates, work item management) and participation in testing/UAT.</li>
<li>Ability to analyze operational issues, identify root causes, and implement improvements that enhance accuracy, compliance, and cycle time.</li>
<li>Strong written and verbal communication skills, with the ability to explain claim outcomes and technical concepts clearly and professionally.</li>
</ul>
Preferred Qualifications
<ul>
<li>Experience applying Lean and Six Sigma methodologies to drive process improvements</li></ul> 


Salary Band: 6A

#LI-SC1

This selected candidate will be expected to work hybrid in Indianapolis, IN or Portland, ME. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team building and collaboration.

We offer a comprehensive total rewards package designed to support you both at work and at home. Full‑time and part‑time associates working 30 or more hours per week are generally eligible for benefits, including but not limited to:
<ul>
<li>Medical &amp; prescription, dental, vision insurance</li>
<li>Health Savings Account &amp; Flexible Spending Accounts</li>
<li>Paid Time Off</li>
<li>10 weeks 100% paid parental leave (after completing 12 months of employment)</li>
<li>401(k) Plan with company match</li>
<li>Pension Plan</li>
<li>Company paid life &amp; disability insurance</li>
<li>Wellness Program &amp; Company paid employee assistance program</li>
<li>Clinic access subject to location* (*Indianapolis, Charlotte, Cincinnati)</li>
</ul>
If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York.

Selected employees must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship.

Disclaimer: American United Life Insurance Company (&ldquo;OneAmerica Financial&rdquo;) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee based on race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, gender identity), age, physical or mental disability, veteran or military status, genetic information, citizenship, or any other legally recognized protected basis under federal, state, or local law.

For all positions:

Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered.

To learn more about our products, services, and the companies of OneAmerica Financial, visit oneamerica.com/companies.
Equal Opportunity Employer 
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.</div>

Supplemental Health Claims Manager

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.<div>
Position Summary
Provides strategic ownership of Claims workforce management by leveraging deep analytical expertise to forecast demand, develop capacity and staffing models, and optimize workforce utilization. Serves as the primary subject matter expert for Claims Workforce Management (WFM), partnering closely with senior leadership and cross‑functional stakeholders to support operational decision-making, performance outcomes, and scalability. Leads workforce planning initiatives, drives process improvements, and delivers actionable insights to ensure claims operations are staffed efficiently, consistently, and in alignment with business objectives.<ul><li>The position may be remote or hybrid anywhere in the US depending on candidate location and commute to a hub location</li></ul>
What you will do<ul><li>
Owns end-to-end workforce management for Claims operations, including forecasting, capacity planning, staffing models, and resource optimization across multiple work areas.</li><li>
Analyzes and interprets complex operational, volume, and productivity data to develop actionable workforce strategies that support claims performance, service levels, and financial targets.</li><li>
Develops demand forecasts and staffing models using historical data, trend analysis, and scenario modeling; provides insights and recommendations to senior leadership.</li><li>
Serves as the primary owner of staffing assumptions, workforce modeling, and capacity planning for Claims, ensuring alignment with operational strategy and business priorities.</li><li>
Leverages workforce management tools, statistical models, and analytics to evaluate demand variability, staffing risk, and operational scenarios.</li><li>
Partners closely with Claims leadership, Finance, HR, and Operational Excellence teams to align workforce strategies with hiring plans, training timelines, and productivity assumptions.</li><li>
Establishes and maintains standardized WFM processes, documentation, and governance to ensure consistency, accuracy, and transparency across Claims operations.</li><li>
Identifies opportunities for automation, process improvement, and efficiency initiatives to improve forecasting accuracy and workforce utilization.</li><li>
Monitors performance metrics and operational outcomes to proactively identify risks, gaps, and opportunities related to staffing and capacity.</li><li>
Provides guidance and subject matter expertise to leaders and stakeholders on workforce-related decisions, tradeoffs, and operational impacts.</li><li>
Owns ongoing monitoring of claims performance against performance guarantees and operational commitments; proactively identifies risk and drives workforce reprioritization or resource reallocation to protect SLA, compliance, and financial outcomes.</li><li>
Supports future scalability of the Claims WFM function, including the potential design and transition to a team-based model as business needs evolve.</li></ul>
Required Qualifications<ul><li>
Minimum 7 years of experience in workforce management, operational analytics, or related roles within healthcare, insurance, or complex operational environments</li><li>
Demonstrated expertise in forecasting, capacity planning, and workforce modeling</li><li>
Strong analytical and problem-solving skills with the ability to translate data into executive-level insights and recommendations</li><li>
Proven ability to operate independently with a high level of ownership and accountability</li><li>
Strong communication skills and experience influencing leaders without direct authority</li><li>
Advanced proficiency with workforce management tools, reporting platforms, and data analysis techniques</li><li>
Experience partnering with senior leadership on staffing strategy and operational planning</li><li>
Experience designing or evolving workforce management operating models</li><li>
Strong business acumen with the ability to balance service, quality, cost, and compliance considerations</li></ul>
Education<ul><li>
Bachelor&rsquo;s degree preferred or equivalent combination of relevant experience, training, and professional development</li></ul></div>
Pay Range
The typical pay range for this role is:
$67,900.00 - $199,144.00 
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company&rsquo;s equity award program. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 07/12/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

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