Manager, Member Claims

This role oversees the Member Claims General Processing Teams responsible for the day-to-day processing and adjudication of medical claims. These teams play a vital role in ensuring the accuracy timeliness and efficiency of claims processing for our employer-sponsored medical plans while addressing complex claims scenarios and maintaining compliance with regulatory and operational requirements.

What youll do:

• Leadership & People Development
  • Lead coach and develop a team of early-career Team Leaders who manage Member Claims Associates.
  • Build leadership capability through structured coaching performance feedback and targeted professional development plans.
  • Model high-quality leadership behaviors that reinforce accountability ownership curiosity and member-first thinking.
  • Foster a positive collaborative and inclusive team culture aligned with Collective Health values.
• Operational Ownership & Performance Management
  • Fully own the Member Claims function; including strategy process development execution and KPI achievement.
  • Ensure accurate timely and compliant medical claims processing across all workstreams maintaining high performance standards in accuracy timeliness and efficiency.
  • Oversee day-to-day operational execution including staffing workload distribution quality assurance up-training and issue resolution.
  • Monitor key operational quality and productivity metrics; leverage performance insights to drive continuous improvement accountability and execute operational excellence.
• Process Improvement & Scaling
  • Identify prioritize and lead strategic initiatives that improve scalability reduce complexity and enhance the member experience.
  • Champion process improvement efforts that streamline workflows reduce variation and support long-term efficiency.
  • Collaborate closely with cross-functional partners (Network Regulatory Compliance Engineering Member Advocacy Quality Assurance etc.) to resolve escalations address root causes and build scalable solutions.
• Cross-Functional Leadership
  • Represent Member Claims as a key leader within the larger health plan operations team partnering with internal and external business partners.
  • Participate in and at times lead cross-functional initiatives that improve system capabilities support new products or evolve our operating model.
  • Influence stakeholders to ensure buy-in for operational changes and broader claims-related initiatives.
• Quality & Compliance
  • Maintain rigorous quality assurance standards to ensure claims are processed accurately compliantly and consistently.
  • Lead investigation of complex and escalated claims issues identifying root causes trends and emerging risks.
  • Own end-to-end correction and resolution including claim rework remediation and implementation of corrective actions.
  • Drive timely escalation resolution in partnership with cross-functional teams and ensure fixes are durable and prevent recurrence.

To be successful in this role youll need:

• 8 years experience in healthcare operations preferably within medical claims health plan operations or a related payer environment.
• To be a strong people leader with 3 years of direct people management experience including coaching early-career leaders and helping them grow.
• Experience managing quantitative process-oriented teams and thrive in back-office environments that require high accuracy and analytical rigor.
• To have led teams through scaling change and operational transformation.
• To be passionate about simplifying healthcare and delivering exceptional experiences for members and clients.
• To be highly analytical use data to drive decisions and can translate insights into clear actionable plans.
• To be energized by developing others strengthening leadership pipelines and building high-performance teams.
• To communicate with clarity empathy and influence across all levels of the organization.
• Bachelors degree or equivalent experience preferred.

Pay Transparency Statement

This is a hybrid position based out of our Plano office with the expectation of being in office at least three weekdays per week.#LI-hybrid

The actual pay rate offered within the range will depend on factors including geographic location qualifications experience and internal addition to the salary you will be eligible for 70000 stock options and benefits like health insurance 401k and paid time off. Learn more about our benefits at TX Pay Range