Head of Claims

Changing Healthcare For Good

At Angle Health we believe the healthcare system should be accessible transparent and easy to navigate. As a digitalfirst datadriven health plan we are replacing legacy systems with modern infrastructure to deliver our members the care they need when they need it. If you want to build the future of healthcare wed love for you to join us.

The Role
Were seeking a seniorlevel leader to serve as our Head of Claimssomeone with deep experience in the TPA space who thrives in fastchanging environments and is eager to build from the ground up. Reporting to our President and GM of Angle Healths TPA (Adrem) this individual will oversee the full claims universe at Angle Healthincluding claims processing appeals audits training and cost containment. This is a highimpact leadership role focused on stabilizing and scaling our claims operation as we grow.

Were looking for someone who isnt afraid of broken processes unanswered questions or startup ambiguity. The ideal candidate can confidently own strategic projects from end to end adapt quickly and help build a claims organization thats efficient compliant and built to scale.

Core Responsibilities:

• Lead and oversee all core functions related to health insurance claims: processing auditing appeals training and network/vendor coordination.

• Supervise and mentor a team of 28 claim processors adjusters auditors and appeal coordinators working closely with our team lead(s) managers etc..

• Lead and manage the claims team with a strong sense of urgency providing clear direction and decisive guidance to ensure timely accurate and efficient resolution of claims.

• Build and refine SOPs and operational workflows across the claims lifecycle

• Conduct performance evaluations and provide training and coaching when necessary

• Foster a positive and productive work environment with the ability to motivate and guide team members resolve conflicts and address performance issues in a constructive manner

• Oversee the processing of health insurance claims and appeals to ensure accuracy and adherence to company policies and procedures as well as state and federal regulations

• Own critical metrics related to accuracy timeliness and compliance

• Review and audit high dollar and complex claims and resolve escalated issues

• Help refine and scale our claims systems in collaboration with plan building as the company grows

• Monitor claim trends utilizing data to target and implement process improvements to enhance efficiencies and reduce errors

• Develop and implement a comprehensive claims auditing and quality assurance program

• Stay updated on changes in health insurance laws and regulations to ensure ongoing compliance

• Work closely with the Care Team to ensure routed service tickets and escalations are handled timely and with a high level of satisfaction addressing and resolving customer complaints

• Prepare track and analyze reports on claim performance including but not limited to daily inventory; monitoring metrics related to processing times accuracy financial impact etc.

• Collaborate with other departments to integrate best practices and enhance overall operational efficiency

• Identify areas of risk or inefficiency and lead corrective action initiatives

• Play a key role in future strategic planning and team expansion as needed

• Maintain and report on staffing analytics

• Other duties as assigned
  

Qualifications:

• Minimum of 5 years of experience in health insurance claims management with a preference of 10 years of health insurance experience

• Senior leadership experience at a Third Party Administrator (TPA) large carrier only experience/backgrounds will not be considered

• Deep knowledge of health insurance claims processing procedures and regulatory requirements

• Excellent leadership and interpersonal skills with a proven track record of effective communication and relationshipbuilding with team members stakeholders and clients

• Nimble adaptable and able to thrive in ambiguity

• Experience managing and developing highperforming teams

Bonus Points

• Experienced in building plans within the VBA Software claims processing system

• Experience working for a healthcare startup

• Experience building and implementing claims auditing protocols

• Understanding of electronic claim exchanges and network routing

• Bachelors degree or equivalent work experience

Titles You May Have Held

• Head of Claims

• Director of Claims

• Director of Claims Auditing

• Senior Claims Manager

• Assistant VP of Claims

The salary range for this job opportunity is $110000 to $140000 per year which is the amount Angle Health anticipates paying for this position at the time of this job posting. The actual base salary offered may differ and will depend on various factors such as geographic location skills qualifications and experience.

About Us
Backed by a team of world class investors we are a healthcare startup on a mission to make our health system more effective accessible and affordable to everyone. From running large hospitals and health plans to serving on federal healthcare advisory boards to solving the worlds hardest problems at Palantir our team has done it all. As part of this core group at Angle Health you will have the right balance of support and autonomy to grow both personally and professionally and the opportunity to own large parts of the business and scale with the company.

Angle Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race religion color national origin gender (including pregnancy childbirth or related medical conditions) sexual orientation gender identity gender expression age status as a protected veteran status as an individual with a disability or other applicable legally protected characteristics. Angle Health is committed to working with and providing reasonable accommodations to applicants with physical and mental disabilities.

A Note on Recruiting Outreach
Weve been made aware of individuals falsely claiming to represent Angle Health using lookalike email addresses (like @). Please note that all legitimate emails from our team come from @. We will never ask for sensitive information or conduct interviews via messaging apps.
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